Objective: To evaluate the influence of aphasia on the cognitive screening test in stroke patients with unilateral cerebral hemispheric lesions.

Method: We evaluated 51 hemiplegic patients with unilateral cerebral hemispheric lesions using CT or MRI. We divided the subjects into three groups according to the presence of aphasia and motor weakness: right hemiplegic patients with aphasia, right hemiplegic patients without aphasia, and left hemiplegic patients. Functional Independence Measure (FIM), Mini-Mental Status Examination (MMSE) and Neurobehavioral Cognitive Screening (NCSE) Tests were applied in all patients.

Results: No differences were observed in motor FIM scores between three groups. Total FIM and cognitive FIM scores

of the right hemiplegic patients with aphasia were lower than those of the other two groups. MMSE and several sub-items of NCSE (orientation, attention, comprehension, repetition, naming and calculation) showed the same results. But the mean scores of memory, similarity, and judgement items in NCSE were higher in the left hemiplegic patients than the right hemiplegic patients. No differences were observed in the construction score.

Conclusion: All three cognitive screening tests used in this study were remarkably influenced by the ability of the language function of the patients. Lack of adequate items to detect right cerebral hemispheric lesions were also noticed. (J Korean Acad Rehab Med 2002; 26: 9-13)

The neurobehavioral cognitive status examination(NCSE), a screening examination tool that assesses cognitive funtion in a brief but quantitative fashion, is used as an independent test of five major areas: language, constructions, memory, calculation and reasoning. The examination also separately assesses levels of consciousness, orientation, and attention. This instrument quickly identifies the intact areas of functioning, yet provides more detailed assessment in the areas of dysfunction. To determine whether the neurobehavioral cognitive status examination is a more sensitive instrument for the detection of cognitive impairment than the minimental state examination(MMSE), we performed these test simultaneously in 26 patients with stroke. The sensitivities were 88.5% for NCSE and 53.8% for MMSE respectively. The sensitivity of NCSE was derived from two features of its design: the use of independent tests to assess skills within five major areas of cognitive functioning, and the use of graded tasks within each of these cognitive domains.

The Neurobehavioral Cognitive Status Examination(NCSE) is a evaluation tool of which many physicians use to assess the cognitive function of neuropychologic patients in a brief and quantitative fashion. We scored 10 components of NCSE in 45 stoke patients and compared the difference in scores between right hemiplegia and left hemiplegia according to lesion side, and we also compared the difference between patients with cerebral infarction and hemorrhage.

This study was intended to know the usefulness of the NCSE in the fields of stroke rehabilitation in which the cognition of patients were very important. The mean scores of the patients caused by infarction was higher than that of the hemorrhage except only repetition of language part, especially the scores of attention and naming were high with statistical significance. The mean scores of the left hemiplegia were higher than that of the right hemiplegia except repetition and calculation but all valuses are not significant. Because the scores of the NCSE are influenced by the language function, it is not so useful in comparing stroke patients according to lesion side. But it is very useful in comparing the difference according to the causes of stroke, infarction or hemorrhage respectively and following up patients intrapersonally as a cognitive evaluation tool.