The "DOC" screen: Feasible and valid screening for depression, Obstructive Sleep Apnea (OSA) and cognitive impairment in stroke prevention clinics

• Published in: PloS one Vol. 12; no. 4; p. e0174451
• Main Authors: Swartz, Richard H, Cayley, Megan L, Lanctôt, Krista L, Murray, Brian J, Cohen, Ashley, Thorpe, Kevin E, Sicard, Michelle N, Lien, Karen, Sahlas, Demetrios J, Herrmann, Nathan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04.04.2017; Public Library of Science (PLoS)
• Subjects: Accuracy; Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Apnea; Best practice; Biology and Life Sciences; Body mass; Body mass index; Brain; Brain research; Cardiovascular disease; Clinics; Cognitive ability; Cognitive disorders; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - epidemiology; Comorbidity; Data processing; Demographic variables; Demographics; Depression (Mood disorder); Depression - diagnosis; Depression - epidemiology; Feasibility Studies; Female; Head injuries; Health risks; Health sciences; Health screening; Hospitals; Humans; Impairment; Male; Mass Screening - methods; Measuring techniques; Medical research; Medicine; Medicine and Health Sciences; Mental depression; Middle Aged; Mood; Multiple sclerosis; Neurological diseases; Neurology; Neuropsychological Tests; Patients; Physical Sciences; Polysomnography; Prevention; Psychiatry; Psychology; Quality of Life; Questionnaires; Research and Analysis Methods; Risk factors; Risk groups; Screening; Sleep; Sleep apnea; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - epidemiology; Sleep disorders; Social Sciences; Stroke; Stroke - epidemiology; Stroke - prevention & control; Studies; Traumatic brain injury; Validity; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0174451

Post-stroke Depression, Obstructive sleep apnea (OSA) and Cognitive impairment ("DOC") are associated with greater mortality, worse recovery and poorer quality of life. Best practice recommendations endorse routine screening for each condition; yet, all are under-assessed, diagnosed and treated. We seek to determine the feasibility and validity of an integrated tool ("DOC" screen) to identify stroke clinic patients at high-risk of depression, OSA, and cognitive impairment. All consecutive new referrals to a regional Stroke Prevention Clinic who were English-speaking and non-aphasic were eligible to be screened. Time for screen completion was logged. DOC screen results were compared to the neuropsychological battery and polysomnogram assessments using a modified receiver operator characteristic and area under the curve analysis. Data is reported to conform to STARD guidelines. 1503 people were screened over 2 years. 89% of eligible patients completed the screen in 5 minutes or less (mean 4.2 minutes), less than half the time it takes to complete the Montreal Cognitive Assessment (MoCA). 437 people consented to detailed testing. Of those, 421 completed the Structured Clinical Interview for Depression within 3 months of screening, 387 completed detailed neuropsychological testing within 3 months, and 88 had overnight polysomnograms. Screening scores combined with demographic variables (age, sex, education, body mass index), had excellent validity compared to gold standard diagnoses: DOC-Mood AUC 0.90; DOC-Apnea AUC 0.80; DOC-Cog AUC 0.81. DOC screen scores can reliably categorize patients in to low-, intermediate- or high-risk groups for further action and can do so with comparable accuracy to more time-consuming screens. Systematic screening of depression, obstructive sleep apnea, and cognitive impairment in 5 minutes or less is feasible and valid in a high volume stroke clinic using the DOC screen. The DOC screen may facilitate improved identification and treatment of these comorbidities to improve function in patients after stroke and in those with other neurological diseases that share these comorbid conditions (e.g. Alzheimer's disease/mild cognitive impairment, Parkinson's disease, Traumatic Brain Injury, multiple sclerosis).