Sensitivity and Specificity of a Five-Minute Cognitive Screening Test in Patients With Heart Failure

Janette D. Cameron, Robyn Gallagher, Susan J. Pressler, Skye N. McLennan, Chantal F. Ski, Geoffrey Tofler, David R. Thompson

Cognitive impairment occurs in up to 80% of heart failure (HF) patients. The National Institute for Neurological Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN) recommend a five-minute cognitive screening protocol, yet to be psychometrically evaluated in HF populations. To conduct a secondary analysis of the sensitivity and specificity of the NINDS-CSN brief cognitive screening protocol in HF patients. The Montreal Cognitive Assessment (MoCA) was administered to 221 HF patients. The NINDS-CSN screen comprises three MoCA items; lower scores indicating poorer cognitive function. Receiver operator characteristic (ROC) curves were constructed, determining the sensitivity, specificity and appropriate cut-off scores of the NINDS-CSN screen. In a HF population aged 76±12 years, 136 (62%) were characterised with cognitive impairment (MoCA <26). Scores on the NINDS-CSN screen ranged from 3-11. The area under the ROC curve indicated good accuracy in screening for cognitive impairment (0.88, p<0.01, 95% CI 0.83 to 0.92). The cut-off score ≤9 provided 89% sensitivity and 71% specificity. The NINDS-CSN protocol offers clinicians a feasible telephone method to screen for cognitive impairment in HF patients. Future studies should include a neuropsychological battery to more comprehensively examine the diagnostic accuracy of brief cognitive screening protocols.