Conceptualizing functional cognition in stroke.
BACKGROUND
Up to 65% of individuals demonstrate poststroke cognitive impairments, which may increase hospital stay and caregiver burden. Randomized stroke clinical trials have emphasized physical recovery over cognition. Neuropsychological assessments have had limited utility in randomized clinical trials. These issues accentuate the need for a measure of functional cognition (the ability to accomplish everyday activities that rely on cognitive abilities, such as locating keys, conveying information, or planning activities).


OBJECTIVE
The aim of the study was to present the process used to establish domains of functional cognition for development of computer adaptive measure of functional cognition for stroke.


METHODS
Functional cognitive domains involved in identifying relevant neuropsychological constructs from the literature were conceptualized and finalized after advisory panel feedback from experts in neurology, neuropsychology, aphasiology, clinical trials, and epidemiology.


RESULTS
The following 17 domains were proposed: receptive aphasia, expressive aphasia, agraphia, alexia, calculation, visuospatial, visuoperceptual, visuoconstruction, attention, language usage, executive functions, orientation, processing speed, memory, working memory, mood, awareness and abstract reasoning. The advisory panel recommended retaining the first 12 domains. Recommended changes included: to address only encoding and retrieval of recent information in the memory domain; to add domains for limb apraxia and poststroke depression; and to keep orientation as a separate domain or reclassify it under memory or attention. The final 10 domains included: language, reading and writing, numeric/calculation, limb praxis, visuospatial function, social use of language, emotional function, attention, executive function, and memory.


CONCLUSIONS
Conceptualizing domains of functional cognition is the first step in developing a computer adaptive measure of functional cognition for stroke. Additional steps include developing, refining, and field-testing items, psychometric analysis, and computer adaptive test programming.
Donovan
Neila J
NJ
VA HSR&D/RR&D Rehabilitation Outcomes Research Center, Gainesville, FL 32608, USA. neilad@phhp.ufl.edu
Kendall
Diane L
DL
Heaton
Shelley C
SC
Kwon
Sooyeon
S
Velozo
Craig A
CA
Duncan
Pamela W
PW
D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D003071:Cognition; D003072:Cognition Disorders / Q000145:classification* / Q000175:diagnosis* / Q000628:therapy; D003198:Computer Simulation; D004185:Disability Evaluation; D006801:Humans; D009483:Neuropsychological Tests / Q000592:standards; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011594:Psychometrics / Q000592:standards; D020521:Stroke / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*