Poststroke Attention Function: A Rasch Analysis of Neuropsychological Tests

抄録

Objectives: The aim of this study was to determine the hierarchy of neuropsychological tests and behavioral observational scale of attention function, using levels of consciousness.

Methods: This single-center, cross-sectional study was conducted at St. Marianna University Yokohama Seibu Hospital (Yokohama, Japan). The study included 54 patients who were admitted to an acute hospital for stroke between September 2022 and February 2023 and consented to participate. The primary outcome was the Wessex Head Injury Matrix (WHIM). The secondary outcomes were tests related to attentional function: Mini-Mental State Examination (MMSE), Digit Span (DS), Trail Making Test (TMT), Frontal Assessment Battery, Symbol Digit Modalities Test (SDMT), and Moss Attention Rating Scale (MARS). We investigated the difficulty levels of five neuropsychological tests, according to levels of consciousness impairment identified by the WHIM.

Results: One hundred and sixty-three measurements were included in the analysis. The WHIM phases showed nearly the same hierarchy as that of the original version. The neuropsychological tests, ranked in decreasing order of difficulty, were TMT-Part B, SDMT, TMT-Part A, DS backward, MMSE, and MARS.

Conclusion: The findings underscore the importance of carefully selecting tests and interpreting results. Certain assessments may be feasible, even in patients with impaired consciousness, whereas other tests may pose challenges, even in patients with relatively good levels of consciousness.