The Oxford Cognitive Screen (OCS-AU): Sensitivity and Specificity of a Stroke-Specific Cognitive Screening Tool

Background: Routine screening of cognitive and mental health is considered best practice post-stroke care. However, empirical evidence to support clinical interpretation of cognitive screening outcomes in relation to neuropsychological functioning and anxiety/depression symptoms is limited. Objectives: The aim of this study was to enhance evidence-based interpretation of the Oxford Cognitive Screen-Australian version (OCS-AU) performance by examining relationships between OCS-AU outcomes with neuropsychological constructs and specific anxiety/depression symptoms.Methods: Fifty-three stroke survivors within 12 weeks post-stroke in Australian rehabilitation services were recruited. Participants completed the OCS-AU, a neuropsychological test battery, the Generalised Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Correlations between OCS-AU outcomes with neuropsychological constructs, and anxiety/depression symptoms were analysed.Results: The OCS-AU subtests Hearts Cancellation, Picture Naming, Number Writing, and Gestural Imitation demonstrated significant correlations with their respective neuropsychological counterparts (r=0.35-0.72, p<0.05), unlike OCS-AU Memory and Executive Function subtests, which demonstrated inconsistent associations with corresponding neuropsychological constructs. OCS-AU domains demonstrated stronger associations with anxiety symptoms than depression symptoms, especially ‘Feeling nervous’, ‘Worrying thoughts’, ‘Trouble relaxing’ and ‘Irritability’ from the GAD-7, and ‘Psychomotor changes’ from the PHQ-9. OCS-AU Executive Function, Memory and Spatial Attention showed the most associations with anxiety and depression symptoms. Conclusions: These findings reveal variable associations between OCS-AU subtests and neuropsychological constructs, with notable limitations in memory and executive function, requiring supplementary assessment when deficits are suspected. Variable associations between OCS-AU domains and specific anxiety/depression symptoms underscore the importance of assessing both cognition and mental health for comprehensive post-stroke evaluation and intervention planning.