Cognitive and Mood Assessment in Stroke Research
Focused Review of Contemporary Studies
Rosalind Lees, MA; Patricia Fearon, MBChB; Jennifer K. Harrison, MBChB;
Niall M. Broomfield, PhD; Terence J. Quinn, MD
Downloaded from http://stroke.ahajournals.org/ by guest on July 31, 2017
Background and Purpose—International guidelines recommend cognitive and mood assessments for stroke survivors;
these assessments also have use in clinical trials. However, there is no consensus on the optimal assessment tool(s). We
aimed to describe use of cognitive and mood measures in contemporary published stroke trials.
Methods—Two independent, blinded assessors reviewed high-impact journals representing: general medicine (n⫽4),
gerontology/rehabilitation (n⫽3), neurology (n⫽4), psychiatry (n⫽4), psychology (n⫽4), and stroke (n⫽3) January
2000 to October 2011 inclusive. Journals were hand-searched for relevant, original research articles that described
cognitive/mood assessments in human stroke survivors. Data were checked for relevance by an independent clinician
and clinical psychologist.
Results—Across 8826 stroke studies, 488 (6%) included a cognitive or mood measure. Of these 488 articles, total number
with cognitive assessment was 408 (83%) and mood assessment tools 247 (51%). Total number of different assessments
used was 367 (cognitive, 300; mood, 67). The most commonly used cognitive measure was Folstein’s Mini-Mental State
Examination (n⫽180 articles, 37% of all articles with cognitive/mood outcomes); the most commonly used mood
assessment was the Hamilton Rating Scale of Depression(n⫽43 [9%]).
Conclusions—Cognitive and mood assessments are infrequently used in stroke research. When used, there is substantial
heterogeneity and certain prevalent assessment tools may not be suited to stroke cohorts. Research and guidance on the
optimal cognitive/mood assessment strategies for clinical practice and trials is required. (Stroke. 2012;43:1678-1680.)
Key Words: cognition 䡲 depression 䡲 methodology 䡲 neuropsychology 䡲 outcomes 䡲 scales 䡲 stroke 䡲 trials
C
ognitive and mood disorders are common stroke sequelae, each affecting approximately one third of stroke
survivors.1 These complications can impair functional recovery2,3 and are important to patients. A recent national priority
setting exercise identified “psychological problems” (particularly dementia and depression) as the most important but
underresearched issues for stroke survivors and caregivers.4
The importance of cognition and mood is recognized in
international guidelines, where their routine assessment is
recommended for all stroke survivors.5
In clinical stroke trials, end points are usually based around
domains of physical function, quality of life, and mortality.6
There is potential benefit in assessing cognition and mood,
both at study recruitment and as the end point. For intervention trials, stroke survivors with substantial cognitive or mood
deficits may be excluded. However, lesser problems with
mood and cognition may still impact on activity and participation outcomes and should be described. Because they have
potential effects on all aspects of recovery, some have argued
that cognitive measures themselves may be a useful “global
outcome” measure for trials.7
Many cognitive/mood assessment instruments are available, but at present, there is no consensus on optimal
measure(s) for use in stroke practice or research. A literature
around stroke trial assessment is emerging, although to date
there has been limited research on the properties of common
cognitive/mood assessments in stroke. We first have to know
which tools are commonly used. We sought to describe the
cognitive/mood assessments used in contemporary published
stroke trials.
Methods
We used a sensitive, focused literature search strategy. After informal review of various titles, we restricted analysis to 16 journals
selected based on relevance to stroke, impact factor, and proportion
of clinical studies. After external review and advice, a further 6
journals were added to broaden the scope of the search. Journals
Received February 6, 2012; accepted February 16, 2012.
Costantino Iadecola, MD, was the Guest Editor for this paper.
From the Institute Cardiovascular and Medical Sciences (R.L., P.F., J.K.H., T.J.Q.), School of Medicine, University of Glasgow, Glasgow, UK; and
the Department of Clinical Psychology Western Infirmary (N.M.B.), Glasgow and Institute Mental Health and Well Being, University of Glasgow,
Glasgow, UK.
The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl/doi:10.1161/STROKEAHA.111.653303/-/DC1.
Correspondence to Terence J. Quinn, MD, Department Academic Geriatric Medicine, Walton Building, Glasgow Royal Infirmary Glasgow, Glasgow,
UK G4 0SF. E-mail [email protected]
© 2012 American Heart Association, Inc.
Stroke is available at http://stroke.ahajournals.org
DOI: 10.1161/STROKEAHA.112.653303
1678
Lees et al
Cognitive/Mood Assessment in Stroke Trials
1679
General Medical: British Medical Journal; Journal of the American Medical Association; Lancet;
New England Journal of Medicine
Gerontology/Rehabilitation: Age and Ageing; Journal of the American Geriatric Society;
Neurorehabilitation & Repair
Neurology: European Journal Neurology; Lancet Neurology; Neurology;
Journal Neurology, Neurosurgery & Psychiatry
Psychiatry: American Journal of Psychiatry; American Journal Geriatric Psychiatry;
International Psychogeriatrics; International Journal of Geriatric Psychiatry
Psychology: Archives of Clinical Neuropsychology; Brain; Journal of International Neuropsychology;
Neuropsychologica
Stroke: Stroke; Cerebrovascular Diseases; International Journal of Stroke
Total papers screened n=80988
Total papers describing stroke survivors n=8826
Stroke papers with cognitive/mood measures n=488
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General Medicine
Gerontology/Rehabilitation
Neurology
Psychiatry
Psychology
Stroke
Total stroke papers
31 6
47 5
83 8
75
12 9
6993
Total with cognitive/mood measures
9
25
111
41
62
240
Stroke survivor studies with cognitive assessment n=408
(84% of all papers with cognitive/mood assessments)
Stroke survivor studies with mood assessment n=247
(51% of all papers with cognitive/mood assessments)
Number differing tests used n=300
Number differing tests used n=67
Figure. Search strategy for assessing cognitive/mood measures in contemporary published stroke trials.
representing general medicine; geriatric medicine/rehabilitation;
neurology; psychology; psychiatry; and stroke were included
(Figure).
Journals were hand-searched for relevant articles January 2000 to
October 2011 inclusive reviewing all content, including letters and
short reports. Inclusion criteria were original research in adult,
human stroke survivors. From these studies, we extracted details on
any cognitive or mood assessments used (including inclusion/
exclusion criteria; primary outcome and secondary outcome[s]).
Selection was deliberately inclusive. Where additional methodology
was described in an online or paper supplement, this was accessed.
We did not contact authors of articles. Where a data set was used
more than once with the same outcomes, only the primary article
was considered.
We used inclusive definitions of cognitive measures (any aspect of
cognitive function including language and visuospatial/constructional skills) and mood. Quality of life or global measures were
included if they had specific cognitive/mood components. Caregiver
assessments and proxy assessments were included if they related to
mood/cognition. Fatigue scales were not considered.
Two researchers (R.L. and J.K.H.) independently handsearched journals and compared results. Resulting lists of cognitive and mood measures were checked for relevance by an
independent clinician (T.J.Q.) and clinical psychologist (N.M.B.).
Final decision on inclusion was by group discussion and consensus. As a further validity check, an independent, blinded researcher (P.F.) hand-searched a random selection of 4 journals
and 4 years. This search did not reveal any new studies,
suggesting validity of the original searches. We described outcomes as absolute numbers of assessments and proportions.
Results
Across 22 journals, the total number of articles was 80 988
with 8826 articles detailing stroke-related original research.
Of these 488 (6%) had used cognitive or mood assessment
scales.
The total number of different cognitive/mood assessments
was 367. Of 67 mood assessment scales used in 247 articles,
the most prevalent was the Hamilton Rating Scale for
Depression (n⫽43 [9% of all articles with cognitive/mood
assessment]). Of 300 cognitive assessment tools (n⫽408
articles), 15 (5%) were diagnostic tests; 86 (29%) were
neuropsychological test batteries or assessed multiple cognitive domains; the remainder assessed single domains.
The most prevalent assessment were Folstein’s MiniMental State Examination (n⫽180 [37%]; Table; onlineonly Data Supplement).
Where cognitive/mood assessments were used, median
number of tests was 2 (interquartile range, 1–3; range, 1–21).
Table. Prevalent Cognitive/Mood Assessment Modalities in
Contemporary, Published Stroke Research, 2000 –2011
Test
No. of Papers
(Percent of Total Papers)
With Cognitive/Mood Assessment
Cognitive measures*
Mini-Mental State Examination
Wechsler Adult Intelligence Scale†
Wechsler Memory Scale†
Informant Questionnaire on Cognitive
Decline in the Elderly
Trail Making A and B
180 (37%)
84 (17%)
44 (9%)
32 (7%)
28 (6%)
Mood measures
Hamilton Rating Scale Depression
43 (9%)
Short Form-36 Health Survey
40 (8%)
Hospital Anxiety & Depression Scale
29 (6%)
Beck’s Depression Inventory
27 (6%)
Geriatric Depression Scale
25 (5%)
*“Authors’ own”/unspecified scales excluded.
†Subscales of battery.
1680
Stroke
June 2012
A cognitive/mood measure was used as primary outcome in
353 (72% of articles with cognitive/mood measure); secondary outcome in 56 (11%); and as inclusion/exclusion criteria
in 59 (12%). Psychiatry journals were most likely to detail
cognitive/mood outcomes in stroke survivors (n⫽41 studies),
although the absolute number of stroke studies in psychiatry
journals was modest (n⫽75).
Discussion
Downloaded from http://stroke.ahajournals.org/ by guest on July 31, 2017
Despite the clinical importance of cognitive and mood disorders, these aspects of stroke are infrequently measured in
clinical trials. Cognitive/mood measures are most often used
as the primary outcome, suggesting that trialists only measure
these domains in studies focused on neuropsychology of
stroke. Our data suggest limited overlap between disciplines;
psychology/psychiatry journals measure cognition/mood but
infrequently study stroke cohorts; the converse is true of
neurology journals. Given the potential effect of cognitive/
mood disorder on global functional outcome,2,3 trialists are
failing to measure what could be an important outcome (or
indeed confounder).
When cognitive/mood assessments are used, there is heterogeneity. We note there were almost as many cognitive
measures as there were studies describing cognitive function.
This in part relates to our inclusive definition, comprising
cognitive screening/assessment; single and multidomain neuropsychological testing; and diagnostic criteria. Even limiting
to single-domain cognitive tests, the substantial heterogeneity
in assessment strategies precludes meaningful between study
comparisons and meta-analyses.
Certain prevalent cognitive/mood assessments may not be
appropriate for stroke cohorts; for example, the Mini-Mental
State Examination is not particularly suited to vascular
cognitive impairment.8 Conversely, certain scales prevalent
in clinical practice9 and with evidence of use in stroke10 were
infrequently used; for example, the Montreal Cognitive Assessment (n⫽2 articles) and the Repeatable Battery for the
Assessment of Neuropsychological Status (n⫽1 article). Despite the variety of validated tools available, some authors
continue to use their own bespoke assessment scales. As well
as illustrating heterogeneity in assessments, our list of outcomes can be used to inform search strategies for future
systematic reviews of diagnostic accuracy.
Our study used a sensitive search strategy, using handsearching and various validity checks. This approach has
previously been successfully used to describe functional
outcomes in the stroke literature.6 The increasing volume and
multidisciplinary nature of stroke research precluded review
across all studies.11 However, our intention was to describe
outcome assessments in popular medical journals rather than
across the complete stroke literature. Our choice of journals
was in keeping with other studies that have used similar
methods.12
Stroke trialists and clinicians are unlikely to be surprised
by our findings; it has long been suspected that we are failing
to capitalize on the potential of cognitive and mood assessments.6,7 Our data provide evidence to support this view and
we hope provide further clear incentive to look toward
standardizing assessments across studies. We would recommend that stroke trialists and clinicians work to produce
guidance on preferred outcome measures for cognitive and
mood disorders informed by robust descriptions of test
accuracy and clinimetric properties of scales in stroke.
Sources of Funding
This work was supported by Chest Heart and Stroke Scotland.
Disclosures
None.
References
1. Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression
after stroke: a systematic review of observational studies. Stroke. 2005;
36:1330 –1340.
2. Pohjasvaara T, Vataja R, Laeppavouri A, Kaste M, Erkinjuntti T.
Depression is an independent predictor of poor long-term functionaloutcome post-stroke. Eur J Neurol. 2001;8:315–319.
3. Patel M, Coshall C, Rudd AG, Wolfe CD. Natural history of cognitive
impairment after stroke and factors associated with its recovery. Clin
Rehabil. 2003;17:158 –166.
4. St George B, Pollock A, Firkins L. Research priorities related to stroke:
results of a James Lind Alliance priority setting project. Int J Stroke.
2011;6(suppl 2):50 –51.
5. Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, et al.
AHA/ASA Scientific Statement. Comprehensive overview of nursing and
interdisciplinary rehabilitation care of the stroke patient. Stroke. 2010;41:
2402–2448.
6. Quinn TJ, Dawson J, Walters MR, Lees KR. Functional outcome
measures in contemporary stroke trials. Int J Stroke. 2009;4:200 –205.
7. Hachinski V. Stroke and vascular cognitive impairment a transdisciplinary, translational and transactional approach. Stroke. 2007;38:
1396 –1403.
8. Blake H, McKinney M, Treece K, Lee E, Lincoln NB. An evaluation of
screening measures for cognitive impairment after stroke. Age Ageing.
2002;31:451– 456.
9. Gorelick P, Scuteri A, Black SE, DeCarli C, Greenberg SM, Iadecola C,
et al. AHA/ASA Scientific Statement. Vascular contributions to cognitive
impairment and dementia. Stroke. 2011;42:2672–2713.
10. Pendelbury ST, Mariz J, Bull L, Mehta Z, Rothwell P. MoCA, ACE-R
and MMSE versus NINDS and Stroke—Canadian Network vascular
cognitive impairment harmonization standards neuropsychological
battery after TIA and stroke. Stroke. 2012;43:464 – 469.
11. Saver JL, Kidwell CS, Liebeskind DS, Starkman S. Acute ischemic stroke
trials. Stroke. 2001;32:275–278.
12. Jadad AR, To MJ, Emara M, Jones J. Consideration of multiple chronicdiseases in randomised controlled trials. JAMA. 2011;306:2670 –2672.
Cognitive and Mood Assessment in Stroke Research: Focused Review of Contemporary
Studies
Rosalind Lees, Patricia Fearon, Jennifer K. Harrison, Niall M. Broomfield and Terence J. Quinn
Downloaded from http://stroke.ahajournals.org/ by guest on July 31, 2017
Stroke. 2012;43:1678-1680; originally published online April 24, 2012;
doi: 10.1161/STROKEAHA.112.653303
Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231
Copyright © 2012 American Heart Association, Inc. All rights reserved.
Print ISSN: 0039-2499. Online ISSN: 1524-4628
The online version of this article, along with updated information and services, is located on the
World Wide Web at:
http://stroke.ahajournals.org/content/43/6/1678
Data Supplement (unedited) at:
http://stroke.ahajournals.org/content/suppl/2012/04/24/STROKEAHA.112.653303.DC1
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Supplemental Material
Table S1a)
Complete list of cognitive measures used in our review of contemporary stroke studies
Aachen aphasia test
10
Abbreviated Mental Test (AMT)
7
AD8
1
Adult memory and information processing battery (AMIPB)
1
Agnosia (unspecified/authors own)
1
Albert cancellation test
1
Alexander Scale
1
Alzheimer's disease assessment scale - cognitive subscale (ADAS-Cog)
3
Amsterdam-nijmegen-everyday-language-test (ANELT)
3
Animal category fluency test
1
Animal naming
4
Animal relocation test
1
Annett’s test
1
Anosognosia (unspecified/authors own)
2
Aphasia battery
2
Aphasia Severity Rating Scale
1
Aphasia Test
10
Apraxia (unspecified/authors own)
10
Attention test battery
1
Auditory Comprehension Test
1
Auditory detection
2
"Authors own"
6
Awareness (unspecified/authors own)
1
Babcock story recall test
1
Baking tray test
1
Balloons test
1
Behavioural dyscontrol scale
1
Behavioural Inattention Test (BIT)
11
Behavioural Neglect Scale
1
Bells test
12
Benson facial recognition
2
Benson test
2
Benson visual retention test
5
Berg perceived exertion scale
1
Bilingual apraxia test (BAT)
1
Bird nest story
1
Bisyllabic word span
1
Blessed dementia scale
4
Blessed functional activity scale
5
Blessed information-memory concentration test
6
Bodypart identification
1
Boston diagnosis aphasia examination
21
Boston naming test
21
Brain impairment inventory
1
Breviano di Patologia della Communicazione test
1
Brief 12 question background information and mental status screening test
1
Brixton spatial anticipation test
4
Buschke's cued recall test
1
California Verbal learning Test (CVLT-II)
5
California Verbal learning Test Children's version (CVLT-II -C)
3
Cambridge Cognitive Examination (CAMCOG)
16
Cambridge Mental Disorders of the Elderly Examination (CAMDEX)
5
Cambridge neuropsychological test automated battery (CANTAB)
3
Camel and cactus test
1
Categorical and alphabetic fluency test
3
Chapman Reading task
1
Checklist cognitive and emotional consequences
1
Child Behavioural Check List (CBL)
1
Choice reaction time
1
Clinical Dementia Rating Scale
6
Clinical Global Impression (CGI)
1
Clinical Interview Schedule (CIS)
1
Clinical observation
1
Clock Drawing
14
Coding tasks
1
Cognitive assessments (unspecified/authors own)
37
Cognitive capacity screening
1
Cognitive Drug Research Computerised Battery (CDR)
17
Cognitive failures questionnaire
1
Cognitive impairment questionnaire (CIMP-QUEST)
1
Cognitive performance scale of nursing home
1
Colour design pair learning
1
Colour trail making
1
Commands test
1
Communicative effectiveness Index
1
Complex Ideational Material
1
Comprehensive aphasia test
1
Concentration difficulties
1
Concept shifting test
1
Confusion assessment method (CAM)
4
Consortium to Establish a Registry for Alzheimer’s Disease (CERAD)
7
Constructional praxis
1
Controlled learning and enhanced real immediate/delayed
1
Controlled oral word association test (COWAT)
8
Corsi's block span tasks
10
Cumulative Illness rating scale
3
Delis-Kaplan executive function system
1
Delirium rating scale
4
Dementia (unspecified/authors own)
9
Design Fluency
1
Diagnostic Interview Schedule (DIS)
1
Diagnostic statistical manual (DSM-III/IV)
24
Digit ordering
1
Digit vigilance tasks
1
Displaced reaction time
1
East Boston Story
1
ENB Neuropsychological battery
1
Environmental sounds test
1
ESPIRIT-Cog
2
Ewart's self efficacy Scale
1
Executive Interview (EXIT-25)
1
Extended range vocabulary test
2
Faced auditory serial attention test
1
Frenchay aphasic screening tests
5
Fifteen word verbal-learning test
3
Figural fluency
1
Figural memory
1
Figural recognition test
2
Figure and shape copying
3
Finger tapping
2
Fluid object memory evaluation
2
Four letter words
1
Frontal assessment battery
1
Functional independence measure cognitive measure (FIM-Cog)
3
Geometric figures
1
Geriatric mental scale schedule
3
Gestault closure
1
Global assessment of functioning scale
1
Global deterioration scale
1
Go-NoGo test
1
Grober and Buschke procedure
3
Groninger Intelligence Test
2
Grooved pegboard
1
Hachinski Scale
3
Hanoi tower
1
Hasegawa dementia rating scale (HDS-R)
1
Hodkinson mental tests of cognitive screening
5
Hooper visual organisation
2
Identification of overlapping figures
1
Incapacity Status Scale
1
Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
32
Informant-rated cognitive decline
2
Integrated visual auditory continuous performance
2
Interactional problem solving inventory (IPSI)
2
International classification of diseases - dementia (ICD-9 )
7
International Classification of Primary Care (ICPC)
1
Interview for deterioration in daily life in dementia
1
Kaufman Short Neuropsychological Assessment (K-SNAP)
2
Language function (unspecified/authors own)
5
Lateralised response test
1
Lateralised target test
1
Letter cancellation
2
Letter digit coding task
1
Letter fluency
4
Letter-digit substitution task
2
LEXIS 80-picture naming test
2
Line Bisection
11
Line Cancellation
2
Location learning
1
Luria alternating sequencing task
1
Luria clock setting and clock reading test
1
Luria Nebraska neuropsychological battery
1
Mattis dementia rating scale
13
Maze task
1
Memory and behaviour problems check list - revised
1
Memory Assessment Scale
4
Memory disturbance (unspecified/authors own)
1
Memory Total (MEMTOT)
1
Mental component summary
3
Mental speed (unspecified/authors own)
1
Mental status (unspecified/authors own)
4
Menu reading
1
Mini Mental State Examination (MMSE)
180
Modified card sorting test
2
Modified fluff test
1
Modified laterally score after Oldfield
1
Modified paced auditorial serial attention test (M-PASAT)
1
Montreal Cognitive Assessment (MoCA)
2
Multi-aphasia examination (MAE)
2
National adult reading test (NART)
9
NINCDS-ADRDN
1
Neglect battery
6
Neuropsychiatric Inventory
2
Neuropsychological tests (unspecified/authors own)
36
Nine hole peg test (NHPT)
1
Non-verbal learning test
1
Non-verbal neuropsychological tests
2
Number recall
2
Object recognition
1
Ontario Society of Occupational Therapy perceptual evaluation battery
1
Oral Reading
1
Organic brain syndrome scale (OBS)
1
Orientation (unspecified/authors own)
1
Orpington prognostic Scale
2
Owens' spatial working memory
1
Paced auditorial serial addition test
1
Paper and Pencil memory scanning test
5
Pattern matrices 1938 (PM38)
1
Pattern recognition memory (PRM)
1
Paediatric stroke outcome measure (PSOM)
2
Phonological verbal fluency
2
Picture copying
2
Picture Scanning
3
Picture word learning task
1
Porch Index of Communicative Ability
1
Protocole d'evaluation Neuropsychologiqit optimal
1
Psychiatric Interview (unspecified/authors own)
4
Psycholinguist Assessment of Language Processing in Aphasia (PALPA)
3
Psychological functioning (unspecified/authors own)
1
Psychomotor speed
3
Pyramids and palm trees test (PPT)
1
Ravens advanced progressive matrices
2
Raven's coloured progressive matrices
7
Raven's standard progressive matrices
6
Reaction level scale
2
Reading test
1
Real object decision task
1
Reinag aphasia test
1
Repeatable battery for assessment of neurological status (RBANS)
2
Repetition (unspecified/authors own)
1
Rey 15-word delayed/immediate recall
3
Rey Auditory verbal learning test (RAVLT)
17
Rey complex figure test (RCFT)
16
Rey-osterrieth memory immediate reproduction
2
Rivermead Behavioural Memory Test (RBMT)
7
Rosen drawing test
2
Salfort Object Recognition Test (SORT)
1
Salpertriere retardation rating scale (SRRS)
1
Schedule for assessment of insight (SAI)
1
Schedule for clinical assessment in neuropsychiatry (SCAN)
1
Screening instrument for neuropsychological impairment in stroke (SINIS)
1
Selective reminding test (SRT)
2
Self ordered pointing task
1
Self portrait
1
Semantic verbal fluency
4
Semantic/phonemic fluency tests
1
Sheffield screening test for acquired language disorders (SST)
4
Short orientation-memory concentration test
1
Short portable mental state questionnaire (SPMSQ)
6
Short term memory (unspecified/authors own)
1
Six-item screener for cognitive impairment
1
Snodgrass and Vanderwart
3
Spatial Corsi span
1
Speed
2
Star cancellation test
4
Starry night test
1
Stick test
1
Story recall
3
Stress resistance
1
Stroke drivers screening assessment
1
Stroke expectations questionnaire (SEQ)
2
Stroke Impact Scale (SIS)
18
Stroop Test
22
Structured clinical interview for DSM-IV patient version (SCID-P-DSM-IV)
1
Structured interview for Alzhiemer’s disease and multi-infarct dementia
1
Structured neurological interview
3
Subjective global assessment (SGA)
1
Symbol-digit modalities test
8
Symptom check list - 90 (SCL-90)
3
Tactile extinction
1
Telephone interview for cognitive status modified (TICS-M)
1
Test battery of attention performance (TAP)
2
Test of everyday Attention (TEA)
6
Test of facial recognition
1
Test of written language (TOWL-3)
1
Test Visual Perceptual Skills (TVPS)
1
Token test
18
Toronto alexithymia Scale (TAS-20)
1
Toronto tower
1
Tower of London (TOL)
1
Trail making A and B
28
Two choice reaction time
1
Utrech communication Observation (UCO)
2
Utrech coping list
1
Vascular dementia assessment scale - cognitive subscale (VADAS-Cog)
1
Verbal and Spatial reasoning test
1
Verbal automatisms
1
Verbal conceptualisation
1
Verbal learning and memory test
2
Vienna Reaction apparatus
1
Vision (bespoke assessment)
1
Visual analogue self-esteem scale (VASES)
1
Visual extinction (unspecified/authors own)
2
Visual inattention (unspecified/authors own)
1
Visual motor Integration (VMI)
1
Visual object and space perception battery (VOSP)
2
Visual reproductions
3
Visual span
2
Visual/hearing reaction time
1
Visuoconstructive function
1
Visuospatial construction
2
Visuospatial perception
2
Wechsler Adult Intelligence Scale (WAIS)
84
Wechsler Individual achievement test
1
Wechsler Intelligence scale for children (WISC)
5
Wechsler Memory Scale (WMS)
44
Wechsler Memory Scale stories (WMSS)
1
Wechsler preschool/primary scale intelligence-revised edition (WPPSI-R)
2
Weigl Card sorting test
2
Weigl Colour form sorting test (WCFST)
5
Western aphasia battery (WAB)
12
WHO Quality of life (WHOQoL)
3
Wide range achievement test (WRAT-R)
3
Williams brain impairment scale
1
Wisconsin card sorting test
8
Word fluency (unspecified/authors own)
3
Word learning (unspecified/authors own)
1
Working memory (unspecified/authors own)
2
Written calculation
1
Zoo test
1
Table S1b) Complete list of mood measures used in our review of contemporary stroke
studies
Anger proneness
3
Anxiety (unspecified/authors own)
2
Astheno-emotional disorder
1
Bakas caregiver outcomes scale
2
Beck's anxiety inventory (BAI)
2
Becks depression Inventory (BDI)
27
Brief assessment schedule for depression cards (BASDEC)
1
Brief Fatigue Inventory (BFI)
1
Caregiver Burden Scale (CBS)
5
Carer strain index (CSI)
7
Center for Epidemiologic Studies Depression Scale (CES-D)
18
Checklist cognitive and emotional consequences
1
Child Depression Inventory (CDI)
1
Comprehensive psychopathological rating scale (CPRS)
1
Cornell Scale
2
Depression (unspecified/authors own)
15
Dutch version of the Depression Adjective Check Lists (VROPSOM)
2
Emotion behaviour index form (EBIF)
1
Emotional Incontinence questionnaire
4
Emotional lability (unspecified/authors own)
3
Geriatric Depression Scale (GDS)
25
Global depression scale
3
Goldberg depression scale (GDS)
3
Hamilton Anxiety Scale
6
Hamilton Rating Scale of Depression (HRSD)
43
Hospital Anxiety and depression scale (HADS)
29
Irritability, depression and anxiety scale (IDAS)
7
Life orientation test-revised (LOT-R)
3
Life satisfaction checklist
1
Mental adjustment to stroke scale (MAS)
1
Mental Health Questionnaire
1
Montgomery Asberg depression rating scale (MADRS)
21
Mood disorders (unspecified/authors own)
1
Negative affect scale
2
New York Emotion Battery
1
Patient carer satisfaction
1
Patient Health Questionnaire -9 (PHQ-9)
10
Positive affect scale
2
Positive aspects of caregiving scale
1
Poststroke depression rating scale (PDRS)
1
Poststroke emotional incontinence (PSEI)
1
Present State Examination (PSE)
10
Profile of mood states - fatigue (POMS - Fatigue)
1
Psychological general well-being Index -10
1
Relatives stress scale
3
Ryff measurement of psychological well-being
1
Satisfaction with stroke care questionnaire (SASC-19)
1
Self rating depression scale (SDS)
3
Sense of coherence (SOC)
1
Sense of competence questionnaire (SCQ)
1
Short form health survey (SF-36)
40
Sickness Impact Scale (SIP)
6
Speiberger trait anxiety scale (STAS)
1
Speilberger State anxiety inventory (SSAI)
1
Speilberger trait anger
1
Stroke Impact Scale (SIS)
18
Structured interview guide for Hamilton depression rating scale (SIGH-D)
1
Structural clinical interview depression (SCID)
11
Substance abuse, psychiatric disorder - lifetime version
1
Symptom check list - 90 - Depression (SCL-90 - D)
3
Visual analogue mood scale (VAMS)
2
Wakefield depression inventory
1
Yale depression scale
3
Yale-Brown Obsessive-compulsive for screening depression
1
Zarit Burden Interview
1
Zung anxiety scale
1
Zung Self-Rating Depression scale (ZSDS)
3