CC BY-NC-ND 4.0 · Neurology International Open 2017; 01(02): E98-E106
DOI: 10.1055/s-0043-103267
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

The Stroop-Interference-NoGo-Test (STING): A Fast Screening Tool for the Global Assessment of Neuropsychological Impairments

Bernhard Fehlmann
1   Klinik Lengg AG, Institut für Neuropsychologische Diagnostik und Bildgebung
,
Hennric Jokeit
1   Klinik Lengg AG, Institut für Neuropsychologische Diagnostik und Bildgebung
› Author Affiliations
Further Information

Publication History

Publication Date:
06 June 2017 (online)

Abstract

Background With the Stroop-Interference-NoGo-Test (STING), we introduce an efficient and sensitive screening tool for the assessment of mild to moderate cognitive impairment. Its development was motivated by the ongoing economization of diagnostics and therapy in clinics as well as by the increased recognition of the effects of cognitive impairments on quality of life and professional reintegration. Established screenings such as the MoCA, MMSE and CAMCOG are either more time-consuming or lack sensitivity with regard to mild to moderate impairments in relevant domains.

Methods STING is based on the idea of an omnibus test. It integrates attentional, lexical-semantic, speed- and inhibitory components. In this way, a basic sensorimotor component is separated from a higher-order cognitive/executive component, which allows for differentiation between cognitive and generalised or merely sensorimotor impairments. The norms are based on data from 907 participants (386 M, 521 F). Its discriminative power was investigated in 64 patients (32 M, 32 F) with heterogeneous, but predominantly mild to moderate neuropsychological impairments.

Results The split-half reliability is essentially r=0.82–0.95. For the parallel-test reliability, the index is r=0.82–0.91, whereas the test-retest stability is estimated somewhat lower (r=0.48–0.81). Practice effects are moderate (7–12%). STING is correlated with many familiar tests, but sets itself apart from mere intelligence testing. Within the age category of 12–34 years, the number of correct items in the more complex second half of the test was predictive for clinical caseness, with a sensitivity of 83% and a specificity of 47%. Between the ages of 35 and 64, the classification was improved by the combination with the ratio of both halves, which represents set-shifting costs. Here the sensitivity of 71% goes hand in hand with a specificity of 70%.

Discussion STING provides a measure that can be considered sufficiently sensitive for use in the global assessment of cognitive impairment. A positive result does not replace a neuropsychological assessment, but indicates the need for one. The test offers an opportunity to neurologists, psychologists and psychiatrists to objectify mild to moderate, transient, or chronic functional impairments and to evaluate their course over time.

 
  • References

  • 1 De Guise E, LeBlanc J, Champoux MC. et al. The mini-mental state examination and the montreal cognitive assessment after traumatic brain injury: An early predictive study. Brain Inj 2013; 27: 1428-1434
  • 2 Nasreddine ZS, Phillips NA, Bédirian V. et al. The montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695-699
  • 3 Jaillard A, Naegele B, Trabucco-Miguel S. et al. Hidden dysfunctioning in subacute stroke. Stroke 2009; 40: 2473-2479
  • 4 Rabadi MH, Rabadi FM, Edelstein L. et al. Cognitively impaired stroke patients do benefit from admission to an acute rehabilitation unit. Arch Phys Med Rehabil 2008; 89: 441-448
  • 5 Mitchell J. The mini-mental state examination (MMSE): An update on its diagnostic validity for cognitive disorders. In: Larner AJ. ed. Cognitive screening instruments. A practical approach. London: Springer; 2013: 15-46
  • 6 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198
  • 7 Kalbe E, Kessler J, Calabrese P. et al. DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia. Int J Geriatr Psychiatry 2004; 19: 136-143
  • 8 Kalbe E, Brand M, Kessler J. et al. Der DemTect in der klinischen Anwendung: Sensitivität und Spezifität eines kognitiven Screeninginstruments. Z Gerontopsychol -Psychiatrie 2005; 18: 121-130
  • 9 Huppert FA, Brayne C, Gill C. et al. CAMCOG – A concise neuropsychological test to assist dementia diagnosis: Socio-demographic determinants in an elderly population sample. Br J Clin Psychol 1995; 34: 529-541
  • 10 De Jager CA, Milwain E, Budge M. Early detection of isolated memory deficits in the elderly: The need for more sensitive neuropsychological tests. Psychol Med 2002; 32: 483-491
  • 11 Goodglass H, Kaplan EF. The assessment of aphasia and related disorders. Philadelphia: Lea and Febiger 1983
  • 12 Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer’s disease. Am J Psychiatry 1984; 141: 1356-1364
  • 13 Kaplan EF, Goodglass H, Weintraub S. The boston naming test. Philadelphia: Lea and Febiger; 1983
  • 14 Uttner I, Wittig S, Von Arnim CAF. et al. Kurz und einfach ist nicht immer besser: Grenzen kognitiver Demenzscreenings. Fortschr Neurol Psychiatrie 2013; 81: 188-194
  • 15 Fehlmann B. Stroop-Interference-NoGo-Test – Entwicklung. Normierung und Validierung eines Screeningverfahrens zur globalen Erfassung neuropsychologischer Beeinträchtigung [Unpublizierte Masterarbeit]. Zürich: Universität Zürich; 2016
  • 16 Müller HJ, Krummenacher J, Schubert T. Aufmerksamkeitsnetzwerke im Gehirn. In: Müller HJ, Krummenacher J, Schubert T. (Hrsg.) Aufmerksamkeit und Handlungssteuerung. Berlin: Springer Berlin Heidelberg; 2015: 103-121
  • 17 Brickenkamp R, Schmidt-Atzert L, Liepmann D. Test d2–Revision. Aufmerksamkeits-und konzentrationstest. Manual. Göttingen: Hogrefe; 2010
  • 18 Rupp S. Semantisch-lexikalische Entwicklungsstörung. In: Thiel MM, Frauer C, Weber S. (Hrsg.) Semantisch-lexikalische Störungen bei Kindern. Sprachentwicklung: Blickrichtung Wortschatz. Berlin: Springer Berlin Heidelberg; 2013: 73-106
  • 19 Jefferies E, Ralph MAL. Semantic impairment in stroke aphasia versus semantic dementia: A case-series comparison. Brain 2006; 129: 2132-2147
  • 20 Rogers TT, Patterson K, Jefferies E. et al. Disorders of representation and control in semantic cognition: Effects of familiarity, typicality, and specificity. Neuropsychologia 2015; 76: 220-239
  • 21 Jokeit H, Grunwald T. Epilepsie und Gedächtnisbeeinträchtigungen. Z Epileptol 2003; 16: 137-143
  • 22 Prins ND, Van Dijk EJ, Den Heijer T. et al. Cerebral small-vessel disease and decline in information processing speed, executive function and memory. Brain 2005; 128: 2034-2041
  • 23 Kaiser S, Mundt C, Weisbrod M. Exekutive Kontrollfunktionen und Neuropsychiatrische Erkrankungen-Perspektiven für Forschung und Klinik. Fortschr Neurol Psychiatrie 2005; 73: 438-450
  • 24 Heise KF, Zimerman M, Hoppe J. et al. The aging motor system as a model for plastic changes of GABA-mediated intracortical inhibition and their behavioral relevance. J Neurosci 2013; 33: 9039-9049
  • 25 Moosbrugger H, Oehlschlägel J. FAIR-2. Frankfurter Aufmerksamkeits-Inventar 2. 2. überarb. ergänzte u. normenaktual. Aufl Bern: Huber; 2011
  • 26 Tukey JW. Exploratory data analysis. Reading: Addison-Wesley; 1977
  • 27 Dilling H, Mombour W, Schmidt MH. Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F) Klinisch-diagnostische Leitlinien. Bern: Huber; 2013
  • 28 Lienert GA, Raatz U. Testaufbau und Testanalyse. 6. Aufl Weinheim: Beltz; 1998
  • 29 Bühner M. Einführung in die Test-und Fragebogenkonstruktion. 3. aktual. Aufl München: Pearson; 2011
  • 30 Jaeschke R, Guyatt GH, Sackett DL. 1994; Users’ Guides to the Medical Literature: III. How to use an article about a diagnostic test B. What are the results and will they help me in caring for my patients?. JAMA 1994; 27: 703-707
  • 31 Goldhammer F, Hartig J. Testwertinterpretation. In: Moosbrugger H, Kelava A. (Hrsg.) Test- und Fragebogenkonstruktion. Berlin: Springer; 2007: 165-192
  • 32 Von Aster M, Neubauer A, Horn R. Wechsler Intelligenztest für Erwachsene (WIE). Deutschsprachige Bearbeitung und Adaptation des WAIS-III von David Wechsler. Frankfurt: Harcourt Test Services; 2006
  • 33 Wechsler D. WAIS-III: Wechsler Adult Intelligence Scale. Administration and Scoring Manual. San Antonio: Psychological Corporation; 1997
  • 34 Zimmermann P, Fimm B. TAP – Testbatterie zur Aufmerksamkeitsprüfung. Version 2.0. Herzogenrath: PSYTEST; 2002
  • 35 Ruff RM, Evans RW, Light RH. Automatic detection vs. controlled search: paper-and-pencil approach. Percept Mot Skills 1986; 62: 407-416
  • 36 Army Individual Test Battery . Manual of directions and scoring. Washington: War Department, Adjutant General’s Office; 1944
  • 37 Spreen O, Strauss E. A compendium of neuropsychological tests. 2nd ed. New York: Oxford University Press; 1998
  • 38 Matthews CG, Klove H. Instruction manual for the Adult Neuropsychology Test Battery. Madison: University of Wisconsin Medical School; 1964
  • 39 Köchert R. Auswirkungen der Ökonomisierung auf die Versorgungsqualität in der Neurologie und Psychiatrie. In: Manzei A, Schmiede R. (Hrsg.) 20 Jahre Wettbewerb im Gesundheitswesen. Wiesbaden: Springer Fachmedien Wiesbaden; 2014: 299-317
  • 40 Neubauer AC, Fink A. Intelligence and neural efficiency. Neurosci Biobehav Rev 2009; 33: 1004-1023
  • 41 Ashendorf L, McCaffrey RJ. Exploring age-related decline on the Wisconsin Card Sorting Test. Clin Neuropsychol 2008; 22: 262-272
  • 42 Marx P, Lenhard W. Diagnostische Merkmale von Screeningverfahren. In: Hasselhorn M, Schneider W. (Hrsg.) Frühprognose schulischer Kompetenzen. Göttingen: Hogrefe; 2010
  • 43 Scheurich A, Brokate B. Neuropsychologie der Alkoholabhängigkeit. Göttingen: Hogrefe; 2009
  • 44 Lovejoy DW, Ball JD, Keats M. et al. Neuropsychological performance of adults with attention deficit hyperactivity disorder (ADHD): Diagnostic classification estimates for measures of frontal lobe/executive functioning. J Int Neuropsychol Soc 1999; 5: 222-233
  • 45 Demakis GJ. Frontal lobe damage and tests of executive processing: A meta-analysis of the category test, stroop test, and trail-making test. J Clin Exp Neuropsychol 2004; 26: 441-450
  • 46 Taylor MJ, Heaton RK. Sensitivity and specificity of WAIS–III/WMS–III demographically corrected factor scores in neuropsychological assessment. J Int Neuropsychol Soc 2001; 7: 867-874