TY - JOUR
T1 - Feasibility of telephone and computerized cognitive testing as a secondary outcome in an acute stroke clinical trial
T2 - A mixed methods sub-study of the AcT Trial
AU - Sujanthan, Sajeevan
AU - Puveendrakumaran, Pugaliya
AU - Dainty, Katie N.
AU - Barense, Morgan
AU - Lanctot, Krista L.
AU - Owen, Adrian M.
AU - Singh, Nishita
AU - Buck, Brian H.
AU - Khosravani, Houman
AU - Coutts, Shelagh B.
AU - Almekhlafi, Mohammed
AU - Appireddy, Ramana
AU - Tkach, Aleksander
AU - Mandzia, Jennifer
AU - Williams, Heather
AU - Field, Thalia S.
AU - Manosalva, Alejandro
AU - Siddiqui, Muzaffar
AU - Hunter, Gary
AU - Horn, MacKenzie
AU - Bala, Fouzi
AU - Hill, Michael D.
AU - Shamy, Michel
AU - Ganesh, Aravind
AU - Sajobi, Tolulope
AU - Menon, Bijoy K.
AU - Swartz, Richard H.
N1 - Publisher Copyright:
© European Stroke Organisation 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
PY - 2025/9
Y1 - 2025/9
N2 - Introduction: Post-stroke cognitive impairment is associated with impaired quality of life. Remote testing provides a potential avenue to measure cognitive outcomes efficiently. Patients and Methods: Prospective cognitive outcomes were collected at 90–180 days using both telephone MoCA (T-MoCA; range 0–22; <17 impairment) and Creyos, a computerized cognitive battery. Key variables associated with completion were assessed using logistic regressions. Mixed methods brief structured interviews and exit survey were performed to explore barriers to completing computer testing. Results: Of 791 potentially eligible patients (mean age 70 ± 14 years), there was low feasibility of remote cognitive testing, with only 401 (51%) completing the T-MoCA, and 242 (31%) completing Creyos. Our regression models show that age (ORT-MoCA: 0.95 (95% Confidence Interval (CI): 0.94–0.97); ORCreyos: 0.95 (95% CI: 0.94–0.96)), functional impairment (mRS 2–5; ORT-MoCA: 0.55 (95% CI: 0.37–0.81); ORCreyos: 0.66 (95% CI: 0.44–0.98)), quality of life (EQ-VAS; ORT-MoCA: 1.02 (95% CI: 1.01–1.03); ORCreyos: OR:1.02 (95% CI: 1.01–1.03)) and length of hospital stay (ORT-MoCA: 0.98 (95% CI: 0.96–0.99); ORCreyos: 0.97 (95% CI: 0.94–0.99)) predicted both telephone and computer cognitive test completion; computer literacy predicted computer test completion (ORCreyos: 1.12 (95% CI: 1.04–1.21)). In interviews, a preference for accessibility of computerized testing was reported. Discussion: Remote cognitive testing has limited feasibility as a secondary outcome in large acute stroke trials. Patients who are older, with worse quality of life, or severe functional impairment post-stroke are less likely to complete remote cognitive outcomes. Conclusion: Innovative approaches to post-stroke cognitive outcomes in acute stroke trials are needed. Data Access: Data available upon request.
AB - Introduction: Post-stroke cognitive impairment is associated with impaired quality of life. Remote testing provides a potential avenue to measure cognitive outcomes efficiently. Patients and Methods: Prospective cognitive outcomes were collected at 90–180 days using both telephone MoCA (T-MoCA; range 0–22; <17 impairment) and Creyos, a computerized cognitive battery. Key variables associated with completion were assessed using logistic regressions. Mixed methods brief structured interviews and exit survey were performed to explore barriers to completing computer testing. Results: Of 791 potentially eligible patients (mean age 70 ± 14 years), there was low feasibility of remote cognitive testing, with only 401 (51%) completing the T-MoCA, and 242 (31%) completing Creyos. Our regression models show that age (ORT-MoCA: 0.95 (95% Confidence Interval (CI): 0.94–0.97); ORCreyos: 0.95 (95% CI: 0.94–0.96)), functional impairment (mRS 2–5; ORT-MoCA: 0.55 (95% CI: 0.37–0.81); ORCreyos: 0.66 (95% CI: 0.44–0.98)), quality of life (EQ-VAS; ORT-MoCA: 1.02 (95% CI: 1.01–1.03); ORCreyos: OR:1.02 (95% CI: 1.01–1.03)) and length of hospital stay (ORT-MoCA: 0.98 (95% CI: 0.96–0.99); ORCreyos: 0.97 (95% CI: 0.94–0.99)) predicted both telephone and computer cognitive test completion; computer literacy predicted computer test completion (ORCreyos: 1.12 (95% CI: 1.04–1.21)). In interviews, a preference for accessibility of computerized testing was reported. Discussion: Remote cognitive testing has limited feasibility as a secondary outcome in large acute stroke trials. Patients who are older, with worse quality of life, or severe functional impairment post-stroke are less likely to complete remote cognitive outcomes. Conclusion: Innovative approaches to post-stroke cognitive outcomes in acute stroke trials are needed. Data Access: Data available upon request.
KW - Stroke
KW - clinical trials
KW - cognitive endpoint
KW - computerized assessment
KW - telephone assessment
UR - https://www.scopus.com/pages/publications/105000199979
U2 - 10.1177/23969873251323171
DO - 10.1177/23969873251323171
M3 - Artículo
C2 - 40071564
AN - SCOPUS:105000199979
SN - 2396-9873
VL - 10
SP - 968
EP - 977
JO - European Stroke Journal
JF - European Stroke Journal
IS - 3
ER -