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From the Department of Neurology, University Hospital Rotterdam-Dijkzigt,
Rotterdam (I. de K., F. van K., D.W.J.D., F. van H., P.J.K.); Julius Center
for Patient Oriented Research, Utrecht University, Utrecht (D.E.G.); and
TNO-PG, Gaubius Laboratory, Leiden (C.K.), the Netherlands.
Correspondence to I. de Koning, Department of Neurology, University Hospital Rotterdam-Dijkzigt, dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands. E-mail dekoning{at}neur.azr.nl
Background and Purpose—Most
mental screening tests focus on the detection of cognitive deficits
compatible with Alzheimer's disease. Stroke patients who
develop a dementia syndrome, however, constitute a more
heterogeneous group with both cortical and subcortical
disturbances. We assessed the diagnostic accuracy
of the CAMCOG (the cognitive and self-contained part of the Cambridge
Examination for Mental Disorders of the Elderly) and the Mini-Mental
State Examination (MMSE) for dementia in patients with a recent
stroke.
Methods—In patients aged 55 and older who were admitted in the
Rotterdam Stroke Databank, cognitive functioning was assessed between 3
and 9 months after the most recent stroke. The "gold standard"
diagnosis of dementia was compatible with the criteria of the
Diagnostic and Statistical Manual of Mental
Disorders, Third Edition, Revised. The CAMCOG
and MMSE scores were obtained independent of the diagnostic
procedure.
Results—Of 300 consecutive patients, 71 (23.7%) were demented.
Sixteen severely demented patients could not be tested and were
excluded. The CAMCOG and MMSE scores were significantly related to
dementia (both P<0.0001) in a logistic regression
model. Receiver operating characteristic analysis showed that
the CAMCOG was a more accurate screening instrument (area under the
curve for CAMCOG, 0.95; for MMSE, 0.90). Two other clinical
variables independently improved the diagnostic
accuracy of the MMSE and CAMCOG: patients with a left hemispheric
lesion had a lower (odds ratio, 0.3; 95% confidence interval, 0.1 to
0.7), and patients with hemorrhagic stroke had a greater chance of
being demented (odds ratio, 3; 95% confidence interval, 1 to 10). The
effect of left hemispheric lesion as an independent
diagnostic factor could not be explained by selection or
its association with aphasia alone.
Conclusions—The CAMCOG is a feasible instrument for use in
patients with a recent transient ischemic attack or stroke. It
is a more accurate screening tool for dementia than the MMSE,
especially when type and site of stroke are taken into account.
© 1998 American Heart Association, Inc.
Original Contributions
The CAMCOG: A Useful Screening Instrument for Dementia in Stroke Patients
Key Words: cognitive screening • dementia • neuropsychological tests • stroke
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