Cognitive assessment at bedside for iPad: A preliminary validation of a novel cognitive test for stroke patients

Abstract

Introduction: Cognitive impairments are frequent in stroke. Cognitive testing is important for research, prognostication and planning in sub-acute stroke, but poses difficulties due to aphasia, hemineglect, hemiplegia and fatigue. We present the first steps towards a validation of a novel iPad-based test battery: Cognitive Assessment at Bedside for iPad (CABPad).

Patients and methods: Stroke patients and age matched healthy controls were tested with CABPad including tests for aphasia, neglect, episodic memory, attention span, executive function, working memory, mental speed, anosognosia, motor speed and depression. A re-test was performed after 1 month. Furthermore, a group of stroke patients was tested with CABPad and traditional neuropsychological tests.

Results: Fifty-four patients and 48 healthy controls were included in the first phase. Fifty-three patients (98%) were able to complete at least one test and 50 (92%) all tests at the first test point. Mean test duration in patients was 39 min (range 30-60). We found significant differences in test results at baseline between the two groups. Episodic memory mean difference: 8.5 (95% confidence interval: 4.3, 12.7). Symbol Digit Coding mean difference: 16.3 (95% confidence interval: 10.8, 21.7). The second phase included 16 patients. We found adequate to excellent correlation in the majority of the tests. The CABPad Speech Comprehension test and the Auditory Word Recognition subtest of the Western Aphasia Battery correlated with r = 0.82, p < 0.001.

Conclusion: CABPad is useful for cognitive testing in stroke patients. It is easy to use for the examiner and patients alike. Immobile patients can be tested at bedside, irrespectively of upper extremity paresis, and the assessment can be performed in a relatively short timespan.

Keywords: Stroke; aphasia; cognitive symptoms; episodic memory; hemispatial neglect; neuropsychological test.