Oxford Cognitive Screen
Oxford Cognitive Screen: A stroke-specific tool to assess post-stroke cognitive problems
For a long time, treatment for people affected by stroke has focussed on obvious changes like arm or leg strength and speech. However, more hidden effects of the stroke can have a major impact on people’s life once back home. Indeed, the psychological consequences of stroke are some of the most disabling. Whilst stroke is an acute medical emergency, it is also a long-term condition. Instead of being the same as before a stroke, people must adjust to a new life which often includes changes in cognitive abilities. People living with stroke consistently report managing of mood and cognitive changes as their greatest challenge.
Immediately following a stroke almost everyone experiences cognitive impairments. These may include difficulties with understanding, reading, writing, remembering, spatial awareness and planning activities. Failure to detect these changes can have a significant impact on post-stroke recovery. Cognitive screening is vital to facilitate rehabilitation, ensure appropriate support and enhance the quality of life of stroke survivors.
Until recently, the brief tools used for assessing post stroke cognitive problems were ‘borrowed’ from other conditions such as Alzheimer’s disease. Under the leadership of Professor Nele Demeyere, researchers at the University of Oxford developed The Oxford Cognitive Screen (OCS). The OCS was the first pragmatic bed-side tool providing a short, neuropsychology based cognitive assessment, in line with NICE guidelines on domain specific screening. This first-line, stroke-specific cognitive screen – following rigorous neuropsychological and psychometric approaches – assesses different cognitive domains relevant to stroke, including attention, praxis, memory, number and language. It was designed for use in time and resource-pressured acute clinical settings.
The OCS cognitive profiles highlight both strengths (preserved abilities) as well as difficulties in an at-a-glance cognitive snapshot. This profile contributes to multi-disciplinary team decisions on treatment plans and post-care discharge. Health service staff have benefitted from an easy-to-use tool allowing emphasis on both patient strengths and weaknesses in cognitive domains, monitoring progress, and improving communication around cognitive areas with patients, carers and other health professionals.
Professor Demeyere and her team have also recently developed OCS-Plus (2022), a computerised tablet- based tool developed to detect more subtle cognitive changes which may otherwise go undetected. The OCS-Plus primarily focusses on briefly assessing domain general performance in Memory and Executive Function. The OCS-plus has been validated and normed in a healthy ageing sample and is undergoing further research for validity of use in specific clinical groups.
Find out more at www.ocs-test.org.
National and global impact
The OCS is licensed free of charge for publicly funded clinical use through Oxford University Innovations, with over 1300 users licenced from 31 March 2014 to 31 Dec 2020. It has been widely adopted for clinical use in the NHS: 169 out of 217 NHS Trusts in England and Wales had taken a licence by July 2020 (see map).
Its impact beyond the UK, has also been significant. The clinical community world-wide has been able to access the OCS via a free of charge licence for publicly funded clinical and research use. There has been global adoption with 13 linguistically validated versions published in peer reviewed publications and a further 22 translations under development.
It is estimated that 100,000 stroke survivors are being screened with OCS every year. The OCS has been included in the Royal College of Physicians clinical Guidelines (2016), the Danish Health Authority guidelines (2021), and the European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment.
Find out more
Learn more about the work of Dr Demeyere and the Translational Neuopsychology Research Group by visiting their webpage.