NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations

Overview

Page 1 of 22

The instruments recommended here are largely consistent with those recommended by the National Institute of Neurological Disorders and StrokeCanadian Stroke Network vascular cognitive impairment harmonization standards 1, with some minor changes. Validation of the long harmonization battery is in process which may inform the need for additional instrument substitutions. We recognize the value of consistency in measurement across studies, as inconsistent outcomes render findings across studies more difficult to reconcile. The presentation of two batteries allows researchers to choose cognitive outcome measures according to the time allowances and resources of each study, as well as the questions being addressed. While consistency across studies is ideal, we recognize that some scientific inquiries or sample populations will require the modification of these tests batteries. For instance, while the Digit-Symbol substitution test (WAIS-III) is recommended as a measure of speeded sequencing, the similar Symbol-Digit Modalities Test might be substituted in samples where populations have major motor deficits (e.g., hemiparesis) as an oral version exists. The instruments below have been selected due to extensive and favorable reliability, construct validity, and predictive utility, and/or history of use in the target patient population. These recommended batteries are aimed to optimize sensitivity to executive and processing speed deficits, while tapping the cognitive domains of memory, language, and visual-spatial functions as well. The Outcomes and End Points Subgroups recommended measures for Emotional and Cognitive Status are listed below. The subsequent pages describe these instruments in further detail. Short Battery (Core Instruments): o o o Center for Epidemiologic Studies Depression Scale (CES-D)* The Montreal Cognitive Assessment (MoCA) Trail Making Test (A&B)

Long Battery (Supplemental Instruments): o o o o o o Digit Symbol subtest of the Wechsler Adult Intelligence Scale III Symbol Search subtest of the Wechsler Adult Intelligence Scale III Stroop Test Hopkins Verbal Learning Test Revised Rey-Osterrieth Complex Figure Copy and Delay Boston Naming Test (BNT) 30-item version

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
o Information Questionnaire for Cognitive Decline in the Elderly (IQCODE)* Neuropsychiatric Inventory (NPI) Questionnaire

Page 2 of 22

Additional instrument (Supplemental Instrument): o Telephone Interview for Cognitive Status (TICS)

Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, Powers WJ, DeCarli C, Merino JG, Kalaria RN, Vinters HV, Holtzman DM, Rosenberg GA, Wallin A, Dichgans M, Marler JR, Leblanc GG. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 2006;37(9):2220-2241. * Information about the instrument is included in a separate CRF Module and is therefore not included in this document.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations

Page 3 of 22

The Montreal Cognitive Assessment (MoCA) Core/Primary Instrument also recommended by the Stroke Presentation Subgroup Purpose The MoCA screens patients who present with mild cognitive complaints and normal mini-mental state examination (MMSE) scores for mild cognitive impairment (MCI). 2 While the MMSE is a ubiquitous cognitive screening instrument, its relative insensitivity to executive dysfunction and the focal cognitive deficits 3 that can often been seen in stroke render it suboptimal for cerebrovascular populations. In fact, a recent study4 demonstrated the underestimation of cognitive deficits by the MMSE versus the MoCA in individuals with TIAs and stroke in a large population based study. Overview The MoCA is a screening test of cognition with favorable psychometric properties. 2 It screens eight domains: Visuospatial/executive, Naming, Memory, Attention, Language, Abstraction, Delayed recall, and Orientation. Time The assessment takes approximately 10 minutes. Scoring The total possible score is 30 points (total for each domain: Visuospatial/executive 5, Naming 3, Memory None, Attention 6, Language 3, Abstraction 2, Delayed recall 5, Orientation 6). A normal score is greater than or equal to 26 points. The suggested cut-off score [MCI or Alzheimer's disease (AD)] is any score less than 26. One point is added for an individual who has 12 years or fewer of formal education; however the total possible score remains the same. Note that additional studies of optimizing cut-points in different populations are currently underway. Psychometric Properties There are strong validation studies emerging across patient populations (e.g., cerebrovascular, MCI/AD, Parkinsons disease). 1,5,6 Other Important Notes Available in various languages (currently 31 total). Raters using this at admission or discharge should develop a standard methodology and scoring instructions for use in hospital setting. Copyright Information

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations

Page 4 of 22

Universities/ Foundations/ Health Professionals/ Hospitals/Clinics/ Public Health Institutes: MoCA may be used, reproduced, and distributed, WITH prior written permission. The test should be made available free of charge. Commercial Entity/ Pharma sponsored research: MoCA may be used, reproduced, and distributed, WITH prior written permission and Licensing Agreement. The test should be made available free of charge. For additional information, please visit website: http://www.mocatest.org/. References 1 Luis C., Keegan A, & Mullan, M (2009). Cross validation of the Montreal cognitive assessment in community dwelling older adults residing in the southeastern US. International Journal of Geriatric Psychiatry, 24: 197-201.
2

Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 53(4): 695-699.
3

Naugle, R., & Kawczak, K. (1989). Limitations of the Mini-Mental State Examination. Cleveland Clinic Journal of Medicine, 56, 277-281.
4

Pendlebury ST, Cuthbertson FC, Welch SJ, Mehta Z, Rothwell PM. (2010). Underestimation of cognitive impairment by mini-mental state examination versus the montreal cognitive assessment in patients with transient ischemic attack and stroke: a population-based study. Stroke. 2010 Jun;41(6):1290-3. Epub 2010 Apr 8.
5

Popovic, IM, Seric, V, & Demarin, V. (2007). MCI in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci, 257, 185-193.
6

Zadikoff, C., Fox, SH, Tang-Wai, DF, Thomsen, T., de Bie, RM, Wadia, P, Miyasaki, J., Duff-Canning, S., Lang, AE, & Marras, C. (2008). A comparison of the MMSE to the MoCA in identifying cognitive deficits in PD. Mov Disord, 23, 297-299.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
Trail Making Test (A&B) Core/Primary Instrument

Page 5 of 22

Purpose The Trail Making Test is a measure of executive ability. The Trail Making Test is one of the most sensitive measures of cognition. For instance, it has been shown to discriminate between those with presymptomatic Alzheimer's disease (AD) and those who remain without dementia over time.1 Overview The first part of this test, Trails A, requires the subject to rapidly sequence numbers from 1 through 25, with the score being the time to complete the task. The second part, Trails B, is a more difficult cognitive flexibility task requiring the subject to follow a sequential pattern while shifting cognitive sets, sequencing from 1 to 13 while switching between numbers and letters (i.e., 1-A-2-B, etc), with the score being the time to complete the task. The measure of interest is Trails B. Its utility and psychometric properties are so well accepted that it is one of the few measures that it is used across neurologic and psychiatric clinical and research patient populations.5 Time The assessment takes approximately 2-4 minutes for each portion. Scoring Scoring of A and B are reported as the number of seconds required to complete the task. Higher scores indicate greater impairment. Performance varies by age and education, and thus normative standards are used to classify patient performance. 3 Errors affect the patients score only in that the correction of errors is included in the completion time for the task. If a patient has not completed both parts after five minutes, it is unnecessary to continue the test. Psychometric Properties Interrater reliability has been found to be high for both A and B. 2 Other Important Notes The TMT is ubiquitous in clinical and research practice, across patient populations. 4 Copyright Information PAR, Inc. offers the Comprehensive Trail-Making Test (CTMT), a standardized set of five visual search and sequencing tasks. For additional information, visit: http://www4.parinc.com/Products/

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations

Page 6 of 22

SpecialtyAutomated Systems Corporation offers an online version of the Trail Making Test. For more information, visit: http://www.trailmakingtest.com/ .

References 1 Chen P, Ratcliff G, Belle S, al. e. Cognitive test that best discriminate between presympomatic AD and those who remain nondemented. Neurology 2000;55:18471853.
2

Fals-Stewart W. An Interrater Reliability Study of the Trail Making Test (Parts A and B). Perceptual and Motor Skills, 1992, 74: 39-42.
3

Heaton, R. K., Grant, I., & Matthews, C. G. (1991). Comprehensive norms for an expanded HalsteadReitan Battery: Demographic corrections, research findings, and clinical applications. Odessa, FL: Psychological Assessment Resources.
4

Lezak, MD., Howieson, DB, & Loring, DW (2004). Orientation and Attention. In: Neuropsychological Assessment: Fourth Edition. (pg. 372-374). Oxford University Press, NY: NY.
5

Reitan RM. (1992). Trail making test. Tucson, AZ: Reitan Neuropsychology Laboratory.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
Digit Symbol subtest of the Wechsler Adult Intelligence Scale III Supplemental Instrument

Page 7 of 22

Purpose This test has been shown to predict group membership defined by processing speed deficits, such as brain-injured versus control samples 1 and has been used as a sensitive outcome in studies identifying predictors of longitudinal decline in elders 2. Overview The digit-symbol subtest measures the time to recode symbol and digit items. The test requires elements of attention, visuoperceptual processing, working memory, and psychomotor speed. Time Assessment takes a few minutes to complete Scoring The score is the number correctly coded from 0-133 in 120 seconds. Psychometric Properties The test demonstrates strong reliability and validity coefficients . 3 Other Important Notes N/A Copyright Information Copyright belongs to Pearson Education Inc. For additional information and to order test material, visit: http://www.pearsonassessments.com/ References 1 DeMonte, VE, Geffen, GM, May, CR, & MacFarland, K. (2009). Improved sensitivity of the rapid screen of mild traumatic brain injury. J Clin Exp Neuropsychology, 6, 111.
2

Knopman, DS, Mosley, TH, Catellier, DJ, Coker, LH, Atherosclerosis risk in communities study brain MRI study (2009). Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: the ARIC MRI study. Alzheimers & Dementia: the Journal of the Alzheimers Association, 5, 207-214.
3

Wechsler D. (1997). Wechsler adult intelligence scale-III. New York: Psychological Corporation.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
Symbol Search subtest of the Wechsler Adult Intelligence Scale III Supplemental Instrument

Page 8 of 22

Purpose The symbol-search subtest of the WAIS III is an indicator of processing speed and visual perception. Overview The symbol-search subtest requires rapid identification of targets. Specifically, for each item the subject must search a series of five figures to see if either of two targets occur, and mark yes or no for each item. Recent fMRI findings have shown greater activity in the left dorsolateral prefrontal cortices associated with slower symbol search performance.1 This subtest and the Digit-Symbol subtest together comprise the Processing Speed Index of the WAIS-III. Scoring The score is the number correct in 120 seconds from 0-60. Time Assessment takes approximately 3 minutes. Psychometric Properties The subtest has shown validity in studies of adults with various neurological disorders.2 Other Important Notes N/A Copyright Information Copyright belongs to Pearson Education Inc. For additional information and to order test material, visit: http://www.pearsonassessments.com/ References 1 Sweet LH, Paskavitz JF, OConnor MJ, Browndyke JN, Wellen JW, Cohen RA (2005). FMRI correlates of the WAIS-III Symbol Search subtest. J of Int Neuropsychological Society, 11, 471-6.
2

Wechsler D. (1997). Wechsler adult intelligence scale-III. New York: Psychological Corporation.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
Stroop Test Supplemental Instrument

Page 9 of 22

Purpose The Stroop test is a measure of the ability to inhibit overlearned responses in the face of conflicting information. Overview The Stroop test involves three trials. First, in the WORD trial, the subject reads words of color names (e.g., red, blue) printed in black ink. Second, in the COLOR trial, the subject identifies colors (e.g., XXXX printed in red or blue). Finally, in the COLOR-WORD response inhibition trial, the subject must name the color in which a word is presented, while ignoring the printed word. Thus, incongruence between the words color and identity (e.g., the word blue presented in red) requires inhibition and response selection.1 In a recent study of white-matter integrity, Stroop scores demonstrated that microstructual white matter abnormalities of frontostriatal-limbic networks are associated with executive deficits. 3 Time Assessment takes approximately 5 minutes. Scoring Scoring is based on the number of correct responses within a specified time. Psychometric Properties In a recent study, microstructual white matter abnormalities of frontostriatal-limbic networks were associated with Stroop performance in depressed patients. 3 A large imaging study of community-dwelling elders found that Stroop performance was related to number of silent lacunar infarcts, larger WMLs, and more prominent cerebral atrophy.2 Other Important Notes N/A Copyright Information Multiple versions of the Stroop test are available. To date, one version of the tests has not been shown to be clearly superior to others. A commonly used version is the Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Test (CWIT). The CWIT consists of the three traditional Stroop trials (color naming, color name reading, interference) as well as a fourth trial in which the subject switches back and forth between naming the dissonant ink colors and reading the conflicting color names. The stimulus booklet and forms are

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations

Page 10 of 22

copyrighted and included as part of the D-KEFS test kit, but can be purchased separately from the test publisher (www.pearsonassess.com).

References 1 Golden & Greshwater (2002). The Stroop Color and Word Test: A Manual for Clinical and Experimental Uses. Wood Dale, IL: Stoelting Co.
2

Koga H, Takashima Y, Murakawa R, Uchino A, Yuzuriha T, Yao H. (2009). Cognitive consequences of multiple lacunes and leukoaraiosis as vascular cognitive impairment in community-dwelling elderly individuals. J Stroke Cerebrovasc Dis. 2009 Jan;18(1):32-7.
3

Murphy CF, Gunning-Dixon FM, Hoptman MJ, Lim KO, Ardekani B, Shields JK, Hrabe J, Kanellopoulos D, Shanmugham BR, Alexopoulos GS (2007). Biological Psychiatry, 61, 1007-10

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
Hopkins Verbal Learning Test Revised Supplemental Instrument

Page 11 of 22

Purpose THE HVLT-R offers a brief assessment of verbal learning and memory (recognition and recall) for individuals 16 years and older. It is easy to administer and score and is well-tolerated even by significantly impaired individuals. 1 Overview The HVLT-R requires recall of a series of 12 words over three learning trials, free recall after a delay, and a recognition trial. Time The assessment takes approximately 5-10 minutes with a 25-minute delay to complete and 2 minutes to score. Scoring Raw scores are derived for Total Recall, Delayed Recall, Retention (% retained), and a Recognition Discrimination Index Psychometric Properties The HVLT-R correlated most strongly with other tests of verbal memory and relatively weakly with a test of general intelligence. 4 The construct validity of the HVLT-R has been shown relative to other standard list learning tasks, 3 and it is sensitive to dementia.2 The HVLT-R has generally modest-to-low one-year testretest stability for several key HVLT-R component process variables. 5 Other Important Notes N/A Copyright Information Copyright belongs to PAR, Inc. For additional information and to order test materials, visit: http://www4.parinc.com/Products/ References 1 Brandt, J. & Benedict, R. (2001). Hopkins Verbal Learning Test-Revised: Professional Manual. PAR: Florida.
2

Hogervorst, E, Combrinck, M, Lapuerta, P et al (2002). The HVLT and screening for dementia. Dementia and Geriatric Cognitive Disorder, 13, 13-20.
3

Lacritz, LH & Cullum, CM (1998). The HVLT and CVLT: A preliminary compassion. Archives of Clinical Neuropsychology, 13, 623-628.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
4

Page 12 of 22

Shapiro AM, Benedict RH, Schretlen Neuropsychologist, 13, 348-358.

5

D,

Brandt

(1999).

The

Clinical

Woods, SP (2005). Test-Retest Reliability of Component Process Variables Within the Hopkins Verbal Learning Test-Revised. Assessment, 12, 96-100.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
Rey-Osterrieth Complex Figure Copy and Delay Supplemental Instrument

Page 13 of 22

Purpose The Rey-Osterrieth Complex Figure (ROCF) test requires the subject to copy a complex geometric figure, providing an index of design reproduction/graphic ability. A recall trial then taps visual memory for the stimuli. 1 Overview The ROCF is a widely used neuropsychological test for the evaluation of visuospatial constructional ability (Copy trial) and visual memory (Immediate Recall, Delayed Recall, and Recognition trials). It consists of three test conditions: Copy, Immediate Recall and Delayed Recall.2 Time The assessment takes approximately 45 minutes, including a 30-minute delay interval (timed). Scoring Drawings are scored based on a 36-point scoring system. The same scoring criteria apply to all three drawing trials. Each of the 18 scoring units is scored based on accuracy and placement criteria. Unit scores range from two (accurately drawn, correctly placed) to zero (inaccurately drawn, incorrectly placed, unrecognizable, omitted).2 Psychometric Properties The test has been extensively validated across populations and has well established normative standards.1 Intercorrelations between the ROCF and other measures, in samples of both normal and brain-damaged subjects, indicate convergent and discriminant validity. It reliably discriminates among brain-damaged, psychiatric, and normal subjects. In addition, the Recognition trial provides incremental diagnostic power compared to using recall trials alone. 2 Other Important Notes N/A Copyright Information Copyright belongs to PAR, Inc. For additional information and test materials, visit: http://www4.parinc.com/Products/ References 1 Lezak M, Howieson DB, Loring DW, Hannay HJ, Neuropsychological Assessment. Oxford University Press. Fischer JS (2004).

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
2

Page 14 of 22

Meyers J, Meyers K (1995). Rey Complex Figure Test and Recognition Trial: Professional Manual. PAR: Florida.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
Controlled Oral Word Association Test (COWAT) (CFL/PRW) Supplemental Instrument

Page 15 of 22

Purpose The COWAT detects changes in word association fluency often found in various disorders. Overview This lexical fluency test requires the participant to produce as many words as possible that start with a specified letter, within a 60 second interval. 1 Studies have shown that deficits in verbal fluency often localize to frontal structures and pathways, and are also associated with progressive dementias. 2,4 Time The assessment time take approximately 4 minutes. Scoring Patients are given three letters, one at a time, and asked to generate a list of words that begin with the specified letter (CFL or PRW). Psychometric Properties The COWAT has high interrater reliability (.99). 3 Other Important Notes Higher education level is associated with better performance on COWAT. There is little evidence of gender differences on COWAT. Copyright Information Copyright belongs to PAR, Inc. as part of the Multilingual Aphasia Examination. For test materials, go to: http://www4.parinc.com/Products/ References 1 Benton, A., & Hamsher, K (1989). Multilingual Aphasia Examination. Iowa City: AJA Associates.
2

Micelli, G., Caltagirone, C., Gainotti, G., et al (1981). Neuropsycholgical correlates of localized cerebral lesions in nonaphasic brain-damaged patients. J of Clin Neuropsychology, 3, 53-63.
3

Ross TP. The reliability of cluster and switch scores for the Controlled Oral Word Association Test. Arch Clin Neuropsychol 2003; 18: 153-64.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
4

Page 16 of 22

Troyer, AK, Moscovitch, M, Winocur, G et al (1998). Clustering and switching on verbal fluency tests in Alzheimers and Parkinsons disease. J of the Intl Neuropsychological Soc, 4, 137-143.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
Boston Naming Test (BNT) 30-item version Supplemental Instrument

Page 17 of 22

Purpose The 30-item version of the BNT was designed to differentiate between Alzheimers disease (AD) and normal subjects. This version is useful for repeated assessments of a naming task, as well as in situations where administration of the complete BNT is not practical.2 Overview The BNT and its short forms are tasks of visual confrontation naming, sensitive to deficits in semantic retrieval. Norms for this 30-item version were developed using a registry including normal controls, mild cognitive impairment (MCI), and AD. 1 Items have been rank ordered in terms of their ability to be named, which is thought to be correlated with their frequency. Time The assessment takes approximately 10 minutes. Scoring Patients have 20 seconds to respond to each item. Each item is scored as correct, correct with semantic cues, or correct with phonemic cues. The total score is the number correct spontaneously or with semantic cues. Psychometric Properties Interjudge and intrajudge reliability were found to be high, average of 89.1% and 97.6% respectively. Overall reliability using a matrix agreement system adjusting for chance was 91.2%.3 Other Important Notes Spanish versions of the BNT are available.4,5 Copyright Information The BNT is available from the Psychological Assessment Resources (PAR), 16130 North Florida Avenue, Lutz, FL 33549. For additional information, please visit: http://www4.parinc.com/Products/ References 1 Jefferson, AL, Wong, S., Gracer, TS, Ozonoff, A, Green, RC, & Stern RA. (2007). Geriatric performance on an abbreviated version of the Boston naming test. Appl Neuropsychol, 14, 215-223.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
2

Page 18 of 22

Mack WJ, Freed DM, Williams BW, Henderson VW (1992). Boston Naming Test: Shortened versions for use in Alzheimers disease. J Gerontol, 47(3): 154-158.
3

Nicholas LE, Brookshire RH, MacLennan DL, Schumacher JG, Porrazzo SA (1988). The Boston Naming Test: Revised Administration and Scoring Procedures and Normative Information for Non-Brain-Damaged Adults. Clinical Aphasiology, 18: 103-115.
4

Pea-Casanova, J, Quinones-Ubeda, S, Gramunt-Fombuena, N, Aguilar, M, Casas, L, Molinuevo, JL, et al. Spanish Multicenter Normative Studies (NEURONORMA Project): norms for Boston naming test and token test. Arch Clin Neuropsychol. 2009; 24(4): 343-354.
5

Ponton, MO, Satz, P, Herrera, L, Ortiz, F, Urrutia, CP, Young, R, et al. Normative data stratified by age and education for the Neuropsychological Screening Battery for Hispanics (NeSBHIS): Initial report. Journal of the International Neuropsychological Society. 1996; 2(2): 96-104.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
Neuropsychiatric Inventory (NPI) Questionnaire Supplemental Instrument

Page 19 of 22

Purpose The NPI-Q is used to measure 12 categories of behavioral disturbance, in particular: Delusions, Hallucinations, Anxiety, Depression/Dysphoria, Agitation/Aggression, Elation/Euphoria, Disinhibition, Irritability/Lability, Apathy/Indifference, Motor Disturbance, Nighttime Behavior Problems, and Problems with Appetite/Eating. The questionnaire is completed by a caregiver and asks whether the patient exhibits each of the behaviors.2 Overview The NPI Questionnaire is a validated caregiver completed questionnaire derived from the original NPI. The questionnaire taps behavioral symptoms commonly observed post-stroke (e.g., disinhibition, apathy, irritability). 1 Time The assessment takes approximately 10 minutes. Scoring The administrator ranks the severity of each behavior exhibited on a scale of 1 to 3, with 3 being the most severe. The total severity score is the sum of the severity scores obtained for each behavioral category. Additionally, the administrator ranks the patients level of distress from each behavior, on a scale of 1 to 5, with 5 indicating the most severe level of distress. The total distress score is the sum of the distress scores obtained for each behavioral category. 2 Psychometric Properties Test-retest reliability of the NPI-Q is acceptable. The NPI-Q provides a brief, reliable, informant-based assessment of neuropsychiatric symptoms and associated caregiver distress that may be suitable for use in general clinical practice. 1 Other Important Notes N/A Copyright Information Copyright belongs to Jeffrey L. Cummings, MD. For additional information and test materials, visit: http://www.mapi-trust.org/services/questionnairelicensing/ and http://npitest.net/index.html

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations

Page 20 of 22

References 1 Kaufer, DI, Cummings, JL, Ketchel, P, Smith, V, MacMillan, A, Shelley, T, Lopez, OL, & DeKosky, ST. (2000). Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. J Neuropsychiatry Clin Neurosci, 12, 233-239.
2

OHara R, Mumenthaler MS, Davies H, Cassidy EL, Buffum M, Namburi S, Shakoori R, Danielsen CE, Tsui P, Noda A, Kraemer HC, Sheikh JI (2002). Cognitive status and behavioral problems in older hospitalized patients. Annals of General Hospital Psychiatry, 1.

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations
Telephone Interview for Cognitive Status (TICS) Supplemental Instrument

Page 21 of 22

Purpose The Telephone Interview for Cognitive Status (TICS) is a brief, standardized test of cognitive functioning that was developed for use in situations where in-person cognitive screening is impractical or inefficient (e.g., large-scale population screening, epidemiological surveys, with patients who are unable to appear in person for clinical follow-up).1 It is also helpful in the diagnosis of documenting progressive impairment, and might also identify incident disease in research populations.3 Overview The TICS is designed to be administered using the telephone, however, it also may be administered face-to-face. The TICS is particularly useful for examining visually impaired individuals and individuals who are unable to read or write, since it does not require vision. The TICS is very brief and tests many of the basic cognitive functions affected by dementia, consisting of an 11-items, that assess a variety of cognitive domains affected by dementing disorders, including orientation to time and place, receptive and expressive language functions, immediate verbal memory, calculation, and verbal abstraction. It successfully differentiates carefully diagnosed Alzheimers disease patients from healthy spouse controls and demonstrates high test-retest reliability in these populations.2 Time The test usually takes less than 10 minutes to administer and score. Scoring The individual item scores are summed to obtain the TICS Total score, ranging from 0 -41. Psychometric Properties The TICS has a high test-retest reliability and excellent sensitivity and specificity for the detection of cognitive impairment. Among elderly populations, TICS scores approximate a normal distribution and are not subject to the ceiling effects that limit the usefulness of many mental status examinations. 1 Other Important Notes The TICS has a modified version, TIC-m, which eliminates items that are difficult to verify in epidemiological study, and also included a delayed recall procedure in an attempt to increase sensitivity.2

Stroke Version 1.0

NINDS Stroke Common Data Element (CDE) Project Stroke Outcomes and End Points Subgroup: Recommendations

Page 22 of 22

Before administering the telephone interview, the examiner must speak with someone at the same location (e.g., family member, caregiver) who will serve as a proctor to ensure that the environment is appropriate for testing and that the examinee is able to hear spoken language at a spoken volume. All examinee responses are recorded verbatim. 1 Copyright Information The TICS is available from the Psychological Assessment Resources (PAR). For additional information, please visit: http://www4.parinc.com/Products/ References 1 Brandt J. (2010). Telephone Interview for Cognitive Status (TICS). PAR. http://www4.parinc.com/Products/Product.aspx?ProductID=TICS
2

Welsh KA, Breitner JCS, Magruder-Habib KM. (1993). Detection of dementia in the elderly using telephone screening of cognitive status. Neuropsychiatry Neuropsychol Behav Neurol. 6:103-110.
3

Plassman BL, Newman TT, Welsh KA, Helms M, Breitner JCS. (1994). Properties of the telephone Interview for Cognitive Status: application in epidemiological and longitudinal studies. Neuropsychiatry Neuropsychol Behav Neurol. 7:235-241

Stroke Version 1.0