Using MemTrax memory test to screen for post-stroke cognitive impairment after ischemic stroke: a cross-sectional study

Xiaoxiao Zhao; Shujuan Dai; Rong Zhang; Xinjie Chen; Mingjie Zhao; Michael F Bergeron; Xianbo Zhou; Junyan Zhang; Lianmei Zhong; J Wesson Ashford; Xiaolei Liu

doi:10.3389/fnhum.2023.1195220

Using MemTrax memory test to screen for post-stroke cognitive impairment after ischemic stroke: a cross-sectional study

Front Hum Neurosci. 2023 Jul 17:17:1195220. doi: 10.3389/fnhum.2023.1195220. eCollection 2023.

Authors

Xiaoxiao Zhao^#^{1

2}, Shujuan Dai^#^{1

2}, Rong Zhang³, Xinjie Chen⁴, Mingjie Zhao^{1

2}, Michael F Bergeron⁵, Xianbo Zhou^{6

7}, Junyan Zhang^{8

9}, Lianmei Zhong^{1

2}, J Wesson Ashford^{10

11}, Xiaolei Liu^{1

2}

Affiliations

¹ Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
² Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China.
³ Department of Neurology, Kunming Second People's Hospital, Kunming, Yunnan, China.
⁴ Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China.
⁵ Department of Health Sciences, University of Hartford, West Hartford, CT, United States.
⁶ Zhongze Therapeutics, Shanghai, China.
⁷ Center for Alzheimer's Research, Washington Institute of Clinical Research, Vienna, VA, United States.
⁸ Department of Clinical Epidemiology and Evidence-based Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China.
⁹ Bothwin Clinical Study Consultant, Shanghai, China.
¹⁰ War Related Illness and Injury Study Center, VA Palo Alto Health Care System (HCS), Palo Alto, CA, United States.
¹¹ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States.

^# Contributed equally.

Abstract

Background: Whereas the Montreal Cognitive Assessment (MoCA) and Addenbrooke's cognitive examination-revised (ACE-R) are commonly used tests for the detection of post-stroke cognitive impairment (PSCI), these instruments take 10-30 min to administer and do not assess processing speed, which is a critical impairment in PSCI. MemTrax (MTx) is a continuous recognition test, which evaluates complex information processing, accuracy, speed, and attention, in 2 min.

Aim: To evaluate whether MTx is an effective and practical tool for PSCI assessment.

Methods: This study enrolled acute ischemic stroke (AIS) patients who have assessed the cognitive status including MTx, clinical dementia rating (CDR), MoCA, Neuropsychiatric Inventory (NPI), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), the National Institute of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and Barthel Index of activity of daily living (BI) combined with the physical examinations of the neurologic system at the 90-day (D90) after the AIS. The primary endpoint of this study was establishing MTx cut-offs for distinguishing PSCI from AIS.

Results: Of the 104 participants, 60 were classified to the PSCI group. The optimized cut-off value of MTx-%C (percent correct) was 78%, with a sensitivity and specificity for detecting PSCI from Non-PSCI of 90.0 and 84.1%, respectively, and an AUC of 0.919. Regarding the MTx-Cp (Composite score = MTx-%C/MTx-RT), using 46.3 as a cut-off value, the sensitivity and specificity for detecting PSCI from Non-PSCI were 80.0 and 93.2%, with an AUC of 0.925. Multivariate linear regression showed that PSCI reduced the MTx-%C (Coef. -14.18, 95% CI -18.41∼-9.95, p < 0.001) and prolonged the MTx-RT (response time) (Coef. 0.29, 95% CI 0.16∼0.43, p < 0.001) and reduced the MTx-CP (Coef. -19.11, 95% CI -24.29∼-13.93, p < 0.001).

Conclusion: MemTrax (MTx) is valid and effective for screening for PSCI among target patients and is a potentially valuable and practical tool in the clinical follow-up, monitoring, and case management of PSCI.

Keywords: analyses; assessment; cognitive impairment; cross-sectional; executive function; stroke.

Grants and funding

This work was supported by the Yunnan Province Clinical Research Center for Neurological Diseases (Grant no. 202102AA100061 to LZ), the National Natural Science Foundation of China (Grant no. 82160272 to XL), and the Research Program of Yunnan Science and Technology Department [Grant nos. 2019FE001 (-222) and 202101AT070151 to XL].