Bedside screening for executive dysfunction in patients with subcortical ischemic vascular disease

Area of Science:

• Neuroscience
• Clinical Neurology
• Cognitive Psychology

Background:

• Subcortical ischemic vascular disease (SIVD) often presents with dysexecutive syndrome.
• Routine clinical diagnostics for SIVD-related dysexecutive syndrome require effective bedside tests.

Purpose of the Study:

• To evaluate the effectiveness of five executive bedside tests for diagnosing dysexecutive syndrome in SIVD.
• To determine the diagnostic accuracy of CLOX, Tower of London (ToL), Cognitive Estimation Test (CET), verbal fluency, and Five-Point Test in SIVD patients.

Main Methods:

• Examined five executive tests in 17 SIVD patients with cerebral microangiopathy and clinical symptoms.
• Compared SIVD patients to 17 age, gender, and education-matched healthy controls.
• Utilized receiver operating characteristic (ROC) analyses to determine test accuracy (Area Under the Curve - AUC).

Main Results:

• SIVD patients showed significantly lower performance in four of five executive tests (excluding CET).
• CLOX 1 demonstrated excellent diagnostic accuracy (AUC 0.901), ToL (AUC up to 0.845), and phonemic verbal fluency (AUC 0.829) showed good accuracy.
• Figural fluency accuracy was poor to fair (AUC 0.706), with Youden Indices ranging from 0.25 to 0.82.

Conclusions:

• CLOX, ToL, and verbal fluency tests are promising for routine clinical diagnosis of dysexecutive syndrome in SIVD.
• Further psychometric evaluation is recommended, especially for CLOX and ToL.
• These bedside tests can aid in identifying executive dysfunction in SIVD.