Brief cognitive screening of right hemisphere stroke: relation to functional outcome.

Abstract

Traditional mental status screens have limited sensitivity in detection of focal brain damage and are particularly insensitive to right hemisphere stroke (RHS). Addition of a simple measure of constructional ability, clock drawing, should enhance the sensitivity of the Modified Mini-Mental State Exam (3MS) in RHS. The relation between the 3MS-clock drawing screen and functional outcome in RHS was also examined. Logistic regression analysis (Study 1) with cross validation on an independent sample (Study 2). Inpatient medical rehabilitation. Study 1: 32 acute RHS patients (mean age 75.2yrs) and 35 age- and education-matched healthy controls. Study 2 (cross-validation): 32 acute RHS patients (mean age 72.8yrs) and 36 matched healthy controls. 3MS, clock drawing, and Functional Independence Measure scores. The 3MS-clock screen accurately distinguished RHS patients from controls. The clock drawing was a valuable and unique addition to the 3MS. RHS patients who were impaired on the 3MS-clock drawing screen had significantly worse FIM scores at discharge than RHS patients who were not impaired on the cognitive screen. Clinicians can enhance the sensitivity of their brief mental status examination of RHS patients, in addition to obtaining useful prognostic information, by including a clock drawing task in their screen.