Korean-VCI Harmonization Standardization- Neuropsychology Protocol (K-VCIHS-NP) Yeonwook Kang, Ph.D. Department of Psychology, Hallym University Department of Neurology, Hallym University Sacred Heart Hospital April 4, 2009
Outline Overview of the Korean VCI Harmonization Standardization (K-VCIHS) study The Korean VCI Neuropsychology Harmonization Construction of the Korean VCIHS neuropsychology tools Validation of the K-VCI neuropsychology protocol Reliability Validity Preliminary results of the K-VCIHS study
NINDS-Canadian Harmonization Workshop (2005) Stroke 2006;37:2220-2241
NINDS-Canadian Harmonization Workshop Foster multi-center collaboration and communication in the VCI community by coming up with a common core data set Working groups in epidemiology, imaging, neuropsychology, pathology, and experimental (animal) research Stroke 2006;37:2220-2241
Post-Stroke Cognitive Impairments: Prospective Multicenter Observational Study with Korean-Vascular Cognitive Impairment Harmonization Standardization Protocol
Aims of the Study To assess the incidence of newly developed Post-Stroke Dementia (PSD) & Post-Stroke Cognitive Impairment Not Dementia (PSCIND) in patients without pre-stroke dementia at 3 months after ischemic stroke To assess the prevalence of VD & VCIND at 3 months after ischemic stroke To assess the feasibility of K-VCIHS neuropsychological protocol To assess the risk factors of the cognitive impairments at 3 months after ischemic stroke To assess the relationships between the cognitive impairments at 3 months after ischemic stroke and other measures (MRDS, K-IADL, EuroQoL)
Methods Total number of patients: 500 (631) 13 centers over the country Seoul: 6 centers Gyeonggi-Do: 3 centers Busan: 2 centers Daejeon: 1 center Kwangju: 1 center Period: Oct. 1, 2007 ~ Dec. 31, 2008 PI: Dr. Byung-Chul Lee (Hallym University Sacred Heart Hospital) Seoul 6 centers Gyeonggi-Do 3 centers Daejeon 1 center Kwangju 1 center Busan 2 centers
Procedure V0 Enrollment V1 Acute phase evaluation within 14 days V2 Follow-up at 3 months Within 7 days after strokeonset 50% randomization* Informed consent Stroke onset Demographics Blood pressure Stroke risk factors profiles Medical history Concomitant medication Stroke subtypes Brain MRI / MRA ECG & Lab tests NIHSS MRDS (pre-stroke disability) Eligibility criteria K-VCIHS NP section - IQCODE (prestroke dementia) - 5-min K-VCIHS test NIHSS Neurological or medical complications Concomitant medication Vascular clinical outcome Concomitant medication K-VCIHS Neuropsy Test - IQCODE - K-MMSE - 60-min NP battery (30-min NP battery or 5-min NP test) -K-IADL BI, CDR, GDS MRDS, NIHSS, EuroQoL * Randomization: www.stroke-crc.or.kr 206/414 patients (as of Dec 31, 2008)
Culture provides specific models for thinking, acting, and feeling. Cognitive abilities measured by neuropsychological tests represent culturally learned abilities (Uzzell, 2007). The neuropsychological tests must be standardized in populations that are reasonably representative of the patients with whom you will use them. Although most Korean neuropsychological instruments were rooted in the neuropsychological tests originally developed in the United States, they were re-standardized for the Korean people.
NINDS Neuropsychology Protocols 60 Minute Protocol: When domain-specific information is needed for diagnosis of dementia or vascular CIND 30 Minute Protocol: A solid screening examination sensitive to VCI-related deficits 5 Minute Protocol: One that can be completed in a primary care physician s office or as part of a very large epidemiologic project. Also can potentially be administered by telephone
NINDS-CSN Neuropsychology Protocols Emphases in test selections Executive function Processing speed Memory Differentiation from Alzheimer s disease Cognitive domains Executive / Activation Language / Lexical retrieval Visuospatial Memory / Learning Neuropsychiatric / Depressive symptoms Premorbid Status
60-minute Protocol Cognitive Domain VCIHS Tests Korean VCIHS Tests Source Executive / Activation Animal Naming Animal Naming SNSB Phonemic Fluency (CFL, PRW) Phonemic Fluency ( ㄱ, ㅇ, ㅅ ) SNSB Digit Symbol Coding Digit Symbol Coding Korean WAIS Trail Making Test Korean TMT-elderly s version (K-TMT-e) Lee (2006) List Learning Test Strategies Seoul Verbal Learning Test SNSB-II Language BNT-Short form K-BNT: Short form A SNSB Visuospatial Rey: Copy Rey: Copy SNSB Memory Neuropsychiatric / Depressive Symptoms Others Hopkins Verbal Learning Test Seoul Verbal Learning Test SNSB California Verbal Learning Test (alternate) Korean-CVLT Kim & Kang (1999) NPI-Questionnaire version NPI-Q KAGP CES-D GDS, S-GDS SNSB-II IQCODE IQCODE-K Lee (2005) MMSE K-MMSE SNSB MoCA K-MoCA Kang (2009)
TMT: B K-TMT-e: B 1 Monday 2 Tuesday
Rey-Osterrieth Complex Figure
Normative data of the Korean-California Verbal Learning Test (K-CVLT, Kim & Kang, 1999) Subject: N=357 (M: 181, W: 176) Age: 20~79 yrs (49.5 ± 17.4) Men: 49.9±17.6 yrs Women: 49.1±17.2 yrs Norm for each variable Age: 5 categories (20~39, 40~49, 50~59, 60~69, 70~79) Sex
Montreal Cognitive Assessment (MoCA)
K-MoCA
5-min protocol (Subtests from the K- MoCA)
Validation of the K-VCIHS Neuropsychology Protocol (1) Reliability Test-retest reliability Healthy normal elderly N=30 (men: 14, women: 16) Age =71.57±6.40 yrs (range 64~96) Education =7.02±5.19 yrs (range 0~16) Test-retest interval = 27.59±2.06 days (range 24~31)
Table 1. Test-retest reliability of the K-VCIHS NP protocol Test 1st 2nd Intraclass Cor. Animal Naming 15.65 (5.00) 15.14 (4.13).64** Phonemic Fluency 21.14 (9.77) 24.71 (10.69).79*** Digit Symbol Coding 32.69 (13.97) 36.76 (15.92).86*** K-TMT-e: A 41.72 (24.62) 33.69 (16.21).66** K-TMT-e: B 69.04 (31.39) 72.59 (50.15).55** S-K-BNT 10.03 (2.67) 10.97 (2.71).75*** SVLT: Immediate recall 16.93 (4.64) 20.52 (4.43).35* SVLT: Delayed recall 4.93 (2.45) 6.66 (2.59).43** SVLT: Recognition 20.14 (2.17) 20.90 (1.80).45** Rey-Copy 28.69 (5.64) 29.29 (5.18).73*** GDS 10.03 (6.45) 9.24 (5.63).77** K-MMSE 25.59 (2.56) 26.00 (2.85).78*** * p<.05, **p<.01, ***p<.001
Validation of the K-VCIHS Neuropsychology Protocol (2) Validity Stroke patients* (n=56) Healthy normals (n=56) Age (yrs) 65.25 ± 13.74 65.54 ± 12.56 Sex (Men : Women) 28 : 28 28 : 28 Education (yrs) 9.20 ± 5.02 9.08 ± 5.15 * Assessed at the 3 months after ischemic stroke (Hallym University Sacred Heart Hospital; Jan 2008~Dec 2008)
Table 2. Test performances of the stroke patients and healthy normals Test Stroke patients (n=56) Healthy normals (n=56) Animal Naming 12.15 (5.38) 15.25 (4.51) 3.30** Phonemic Fluency 19.92 (12.31) 24.72 (12.27) 1.99* Digit Symbol Coding 38.12 (21.90) 44.27 (24.82) 1.34 K-TMT-e: A 51.53 (54.29) 29.82 (25.13) -2.67** K-TMT-e: B 80.57 (71.07) 57.29 (40.87) -1.98 S-K-BNT 9.91 (3.52) 11.77 (2.94) 3.03** SVLT: Immediate recall 16.48 (5.62) 18.95 (5.45) 2.36* SVLT: Delayed recall 4.21 (2.98) 6.45 (2.68) 4.17*** SVLT: Recognition 19.77 (2.65) 20.57 (2.45) 1.67 Rey-Copy 26.74 (9.62) 29.00 (8.09) 1.35 S-GDS (15) 6.45 (4.55) 3.20 (3.48) 4.25*** K-MMSE 24.61 (4.96) 27.05 (3.60) 2.99** * p<.05, **p<.01, ***p<.001 t
Preliminary results of the K-VCIHS study 5-min protocol (n=59) Scheduled patients for 3-month post-stroke assessment (n=414) 60-min protocol was not administered (n=75) [ neurological / medical conditions, aphasia, pt s refusal, etc.] Patients who completed the 60-min protocol (n=267) ADL missing (n=10) IQCODE missing (n=3) Normal (n=82, 30.7%) VCIND (n=133, 49.8%) VD (n=52, 19.5%)
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