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Introduction

The relevance of assessing cognitive impairments early on after stroke has been largely validated. Several batteries of tests are used in clinical practice today, regardless of having been previously validated for that specific use. In a recent work , we reported the main assessments scales for cognitive disorders and demonstrated the superiority of the Cognitive Assessment scale for Stroke Patients (CASP) over the Mini Mental State Examination (MMSE) and MoCA (Montréal Cognitive Assessment) in terms of feasibility in a population of post-stroke aphasic patients. As a matter of fact, the CASP was specifically designed, both in terms of content and format, for a quick evaluation of post-stroke cognitive disorders at “the patient’s bedside”. Its main characteristics consist in (see details in the primary publication by Barnay et al., ):

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  six cognitive functions being evaluated: language, praxis, short-term memory, temporal orientation, spatial neglect/visual construction, executive functions ( Appendix 1 );

  
  
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  each of the six functions is scored on a scale of 6 (equal weight attributed to each function). The score is expressed either as a profile (i.e. “5-6-4-2-3-4”), or as a total score out of 36;

  
  
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  patients can answer the tests without using language (solely visual tests or designating the right answer among distractors). The CASP can be administered to patients with mutism as long as they retained some oral comprehension for simple orders (BDAE aphasia severity score ≥ 3 for the comprehension dimension );

  
  
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  elements from the test that the patient must look at are systematically ordered in a column and/or placed on the right side of the test sheet to minimize the influence of left unilateral spatial neglect;

  
  
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  it is the only short cognitive evaluation battery containing a test validated specifically for spatial neglect, issued from the French unilateral neglect battery BEN (Batterie d’Evaluation de la Négligence) (20-cm horizontal line bisection test) ;

  
  
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  shorter administration time in aphasic patients (13 ± 4 min).

In our first study we were able to note that when MMSE and MoCA could not be administered to several aphasic patients, it was however possible to administer the CASP in these patients. For other patients, results to the MMSE and MoCA tests evaluating non-language functions were highly influenced by the severity of aphasia, significantly more than for the CASP. Therefore, with the CASP we observed (in this work and in our daily clinical practice) that a significant portion of aphasic patients retained a pretty good orientation to time, an element impossible to verify with the MMSE and MoCA. However, in this study, we experienced great difficulties in administering the CASP in at least one patient presenting major neurovisual impairments (cortical blindness). This observation was expected since CASP items are solely visual-related.

Of course, CASP relevance would be quite limited if it was restricted to aphasic patients (this is why we took into account a possible left spatial neglect in designing the test). The objectives of the present study were to validate the applicability of CASP in non-aphasic stroke patients, assess the influence of neurovisual disorders on CASP administration, and compare CASP scores to those of the MMSE and MoCA.