Adaptation of Oxford Cognitive Screen into Turkish (OCS-TR): Validity and Reliability Study in Stroke Survivors

Overview

Journal BMC Psychol

Publisher Biomed Central

Specialty Psychology

Date 2025 Feb 25

PMID 39994757

Authors

Ozlem Oguz

Bulent Togram

Nele Demeyere

Affiliations

Soon will be listed here.

Abstract

Background: The existing cognitive screening tests used to assess cognitive disorders after stroke in Türkiye face limitations in scope and user applicability. Therefore, this study aimed to address these limitations by adapting the stroke-specific cognitive screening test, the Oxford Cognitive Screen (OCS), into Turkish. Additionally, validity and reliability studies were conducted.

Methods: A total of 114 stroke survivors and 92 healthy individuals participated in the study. Data were collected using the "Participant Information Form," "Oxford Cognitive Screen Turkish Version (OCS-TR)," "Aphasia Language Assessment Test (ADD)," "Montreal Cognitive Assessment Test- Turkish (MOCA-TR)," "Barthel Activities of Daily Living Index (BGYAI)" and "Beck Depression Scale." The team followed an established and detailed step by step process guided by the OCS Concept Elaboration document. Statistical analyses were conducted with IBM SPSS Statistics. Validity and reliability studies, including content validity, known-groups validity, convergent and divergent validity, concurrent validity, internal consistency reliability, test-retest reliability, inter-rater reliability, intra-rater reliability, and parallel forms reliability were conducted to assess the robustness of the measurement instruments.

Results: The language and cultural adaptation process underwent content analysis, adhering to ISPOR and ISOQOL guidelines, resulting in minimal content changes post-pilot study. Notable differences in subtest scores between healthy and stroke participants in both A and B forms of OCS-TR demonstrate known-groups validity, emphasizing superior performance in healthy participants. Strong convergent validity was evidenced by significant correlations with MOCA-TR (r=0.18 to 0.81) and BGYAI (r=0.19 to 0.51), while divergent validity was supported by weak correlations with overall BGYAI scores. Noteworthy correlations between specific subtests of OCS-TR and ADD underscore concurrent validity, with high inter- and intra-rater reliability, internal consistency (α = 0.90 for stroke, α = 0.65 for healthy) and test-retest reliability (r=0.89 to 0.99). Parallel forms reliability was high in both healthy and stroke participants, though significant differences were observed on specific subtests.

Conclusion: The results confirm that the OCS-TR scale can be considered a valid and reliable instrument for assessing cognitive functions in stroke survivors. This stroke-specific tool offers clinicians a comprehensive and inclusive brief cognitive screening tool tailored to the needs of stroke patients.

References

Rotenberg S, Ruthralingam M, Hnatiw B, Neufeld K, Yuzwa K, Arbel I . Measurement Properties of the Multiple Errands Test: A Systematic Review. Arch Phys Med Rehabil. 2020; 101(9):1628-1642. DOI: 10.1016/j.apmr.2020.01.019. View

Tang E, Robinson L, Stephan B . Risk Prediction Models for Post-Stroke Dementia. Geriatrics (Basel). 2019; 2(3). PMC: 6371182. DOI: 10.3390/geriatrics2030019. View

Rost N, Brodtmann A, Pase M, van Veluw S, Biffi A, Duering M . Post-Stroke Cognitive Impairment and Dementia. Circ Res. 2022; 130(8):1252-1271. DOI: 10.1161/CIRCRESAHA.122.319951. View

Hurford R, Charidimou A, Fox Z, Cipolotti L, Werring D . Domain-specific trends in cognitive impairment after acute ischaemic stroke. J Neurol. 2012; 260(1):237-41. DOI: 10.1007/s00415-012-6625-0. View

Delavaran H, Jonsson A, Lovkvist H, Iwarsson S, Elmstahl S, Norrving B . Cognitive function in stroke survivors: A 10-year follow-up study. Acta Neurol Scand. 2016; 136(3):187-194. DOI: 10.1111/ane.12709. View

Robotham R, Riis J, Demeyere N . A Danish version of the Oxford cognitive screen: a stroke-specific screening test as an alternative to the MoCA. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2019; 27(1):52-65. DOI: 10.1080/13825585.2019.1577352. View

Hong W, Tao J, Wong A, Yang S, Leung M, Lee T . Psychometric Properties of the Chinese (Putonghua) Version of the Oxford Cognitive Screen (OCS-P) in Subacute Poststroke Patients without Neglect. Biomed Res Int. 2018; 2018:6827854. PMC: 5987308. DOI: 10.1155/2018/6827854. View

Huygelier H, Schraepen B, Demeyere N, Gillebert C . The Dutch version of the Oxford Cognitive Screen (OCS-NL): normative data and their association with age and socio-economic status. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2019; 27(5):765-786. DOI: 10.1080/13825585.2019.1680598. View

van Heuven W, Mandera P, Keuleers E, Brysbaert M . SUBTLEX-UK: a new and improved word frequency database for British English. Q J Exp Psychol (Hove). 2014; 67(6):1176-90. DOI: 10.1080/17470218.2013.850521. View

10.

Demeyere N, Riddoch M, Slavkova E, Jones K, Reckless I, Mathieson P . Domain-specific versus generalized cognitive screening in acute stroke. J Neurol. 2015; 263(2):306-315. PMC: 4751179. DOI: 10.1007/s00415-015-7964-4. View

11.

Valera-Gran D, Lopez-Roig S, Hurtado-Pomares M, Peral-Gomez P, Garcia-Manzanares M, Sunyer Catlla M . Validation of the Spanish version of the Oxford Cognitive Screen (S-OCS): psychometric properties of a short cognitive stroke-specific screening tool. Clin Rehabil. 2018; 33(4):724-736. DOI: 10.1177/0269215518819046. View

12.

Kong A, Lam P, Ho D, Lau J, Humphreys G, Riddoch J . The Hong Kong version of the Oxford Cognitive Screen (HK-OCS): validation study for Cantonese-speaking chronic stroke survivors. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2015; 23(5):530-48. DOI: 10.1080/13825585.2015.1127321. View

13.

Lesniak M, Bak T, Czepiel W, Seniow J, Czlonkowska A . Frequency and prognostic value of cognitive disorders in stroke patients. Dement Geriatr Cogn Disord. 2008; 26(4):356-63. DOI: 10.1159/000162262. View

14.

Koo T, Li M . A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016; 15(2):155-63. PMC: 4913118. DOI: 10.1016/j.jcm.2016.02.012. View

15.

Mole J, Demeyere N . The relationship between early post-stroke cognition and longer term activities and participation: A systematic review. Neuropsychol Rehabil. 2018; 30(2):346-370. DOI: 10.1080/09602011.2018.1464934. View

16.

Bour A, Rasquin S, Boreas A, Limburg M, Verhey F . How predictive is the MMSE for cognitive performance after stroke?. J Neurol. 2010; 257(4):630-7. PMC: 2848722. DOI: 10.1007/s00415-009-5387-9. View

17.

Sanctuary C, Hewitt L, Demeyere N, Kankkunen K, Oxenham D, Simpson D . The Oxford Cognitive Screen for use with Australian people after stroke (OCS-AU): The adaptation process and determining cut scores for cognitive impairment using a cross-sectional normative study. Aust Occup Ther J. 2022; 70(1):73-85. PMC: 10087605. DOI: 10.1111/1440-1630.12838. View

18.

Nakling A, Aarsland D, Naess H, Wollschlaeger D, Fladby T, Hofstad H . Cognitive Deficits in Chronic Stroke Patients: Neuropsychological Assessment, Depression, and Self-Reports. Dement Geriatr Cogn Dis Extra. 2017; 7(2):283-296. PMC: 5624240. DOI: 10.1159/000478851. View

19.

Tang E, Amiesimaka O, Harrison S, Green E, Price C, Robinson L . Longitudinal Effect of Stroke on Cognition: A Systematic Review. J Am Heart Assoc. 2018; 7(2). PMC: 5850140. DOI: 10.1161/JAHA.117.006443. View

20.

Nys G, van Zandvoort M, van der Worp H, de Haan E, de Kort P, Jansen B . Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke. J Neurol Sci. 2006; 247(2):149-56. DOI: 10.1016/j.jns.2006.04.005. View