Bedside screening for executive dysfunction in patients with subcortical ischemic vascular disease.
OBJECTIVE
We investigated several executive bedside tests for their effectiveness in the routine clinical diagnostics of dysexecutive syndrome in subcortical ischemic vascular disease (SIVD).


METHODS
Five executive tests, CLOX, the Tower of London (ToL), a cognitive estimation test (CET), a verbal fluency test, and the Five-Point Test, were examined in 17 patients with marked cerebral microangiopathy in cranial MRI and clinical symptoms of SIVD. The test accuracy for discriminating the patients from 17 healthy comparison subjects closely matched for age, gender and level of education was determined.


RESULTS
Aside from the CET we found a significant lower performance of the patients with SIVD in four of the five used executive tests. In receiver operating characteristic (ROC) analyses the accuracy of CLOX 1 showed excellent results for distinguishing between patients and comparison subjects (area under the curve (AUC) 0.901), while the ToL (AUC up to 0.845) and the productivity in the phonemic verbal fluency test (AUC 0.829) achieved a good accuracy. Differently the accuracy of the figural fluency was only poor to fair (AUC 0.706). However, the Youden Indices of the significant executive variables showed a wide range from 0.25 to 0.82.


CONCLUSIONS
Based on our data we consider CLOX, the ToL and the verbal fluency test promising executive bedside test concepts for diagnosing the dysexecutive syndrome in SIVD in clinical routine. Particularly for CLOX and the ToL a further psychometric evaluation is required.
Margraf
Nils
N
Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, 24105Kiel, Germany. n.margraf@neurologie.uni-kiel.de
Bachmann
Thomas
T
Schwandner
Wiebke
W
Gottschalk
Stefan
S
Seidel
Günter
G