Abstract T P292: Utility of Depression and Cognitive Impairment Screening during Hospitalization for Acute Stroke
Background: Comprehensive stroke center standards currently require that stroke patients are assessed for cognitive impairment and depression prior to discharge. There is limited data on the utility of cognitive and depression screening within the first week after a stroke.
Methods: We retrospectively identified patients discharged with a primary diagnosis of stroke [ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH)] from January 1 to August 31, 2013 at Emory University Hospital. The Patient Health Questionnaire 2 (PHQ-2) was administered to screen for depression with a score of ≥ 3 considered a positive depression screen. The 6-item screener was administered to screen for cognitive impairment with a score of ≤ 4 considered a positive cognitive impairment screen. Reliability of the screens was determined by comparing results of inpatient and follow-up screens performed 7-14 days after discharge in a subgroup of patients.
Results: Of 315 patients (mean age 61 years, 57% female), 43% had IS (mean NIHSS 8), 31% had SAH (mean Hunt/Hess score 2), and 26% had ICH (mean ICH score 2). Screens were completed (mean 4 days) in 183 (58%) patients, including 64% of IS, 55% of SAH and 46% of ICH patients (IS vs ICH, p=0.01); intubation (32%), delirium (23%), and aphasia (17%) were the most common reasons for inability to complete a screen. A positive depression screen was seen in 22% and a positive cognitive screen in 26% of patients. In age and risk adjusted analysis, history of prior stroke was associated with a positive depression screen (OR 3.39, p=0.01). Having a SAH was a significant predictor of a positive cognitive impairment screen (OR 2.74, p=0.04) while being female was associated with a lower odds of a positive cognitive impairment screen (OR 0.36, p=0.01). Among a random subgroup of 36 patients, reliability of the inpatient screening results was low when compared to screening results after discharge.
Conclusions: More than 40% of stroke patients were unable to complete their inpatient depression and cognitive screens due to acute medical illness. Further study is needed to evaluate the reliability of these screening test results when administered before discharge.
Author Disclosures: K. Owada: None. C. Brasher: None. J. Dunn: None. K. Bryant: None. J. Hockenberry: None. O. Kasshout: None. S. Belagaje: None. R. Dharia: None. A. Anderson: None. H. Smith: None. T. Hoffman: None. K. Caldwell: None. H. Hamby: None. J. Jenkins: None. R. Carkhum: None. C. Pucciano: None. L. Ayala: None. F. Nahab: None.
- © 2015 by American Heart Association, Inc.