title: Sensitivity and Specificity of a Five-Minute Cognitive Screening Test in Patients With Heart Failure.
abstract: BACKGROUND
  Cognitive impairment occurs in up to 80% of patients with heart failure (HF). The National Institute for Neurological Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN) recommend a 5-minute cognitive screening protocol that has yet to be psychometrically evaluated in HF populations. The aim of this study was to conduct a secondary analysis of the sensitivity and specificity of the NINDS-CSN brief cognitive screening protocol in HF patients.
  
  
  METHODS
  The Montreal Cognitive Assessment (MoCA) was administered to 221 HF patients. The NINDS-CSN screen comprises 3 MoCA items, with lower scores indicating poorer cognitive function. Receiver operator characteristic (ROC) curves were constructed, determining the sensitivity, specificity and appropriate cutoff scores of the NINDS-CSN screen.
  
  
  RESULTS
  In an HF population aged 76 ± 12 years, 136 (62%) were characterized with cognitive impairment (MoCA <26). Scores on the NINDS-CSN screen ranged from 3-11. The area under the receiver operating characteristic curve indicated good accuracy in screening for cognitive impairment (0.88; P < .01; 95% CI 0.83-0.92). A cutoff score of ≤9 provided 89% sensitivity and 71% specificity.
  
  
  CONCLUSIONS
  The NINDS-CSN protocol offers clinicians a feasible telephone method to screen for cognitive impairment in patients with HF. Future studies should include a neuropsychologic battery to more comprehensively examine the diagnostic accuracy of brief cognitive screening protocols.
authors.affiliation: Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Electronic address: jan.cameron@acu.edu.au.
authors.forename: Janette D
authors.initials: JD
authors.lastname: Cameron
authors.affiliation: Charles Perkins Centre, Sydney Nursing School, University of Sydney, Sydney, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Gallagher
authors.affiliation: Center for Enhancing Quality of Life in Chronic Illness, School of Nursing, Indiana University, Indianapolis, United States of America.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Pressler
authors.affiliation: School of Psychology, Australian Catholic University, Melbourne, Australia.
authors.forename: Skye N
authors.initials: SN
authors.lastname: McLennan
authors.affiliation: Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
authors.forename: Chantal F
authors.initials: CF
authors.lastname: Ski
authors.affiliation: Management of Cardiac Function Program, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Tofler
authors.affiliation: Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
authors.forename: David R
authors.initials: DR
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011594:Psychometrics; D012372:ROC Curve; D012680:Sensitivity and Specificity
keywords: Heart failure; cognitive impairment; cognitive screening