Executive dysfunction is prevalent in early stroke and can predict long-term outcomes. Impairments can be subtle and undetected in cognitive stroke screens. To better assess executive functions, this study introduced a novel sentence completion test, which assesses multiple executive processes in <5 minutes (Brief Executive Language Screen – Sentence Completion; BELS-SC). The aim was to determine construct, convergent and divergent validity, sensitivity and specificity of the BELS-SC, and to explore differences between left and right hemisphere stroke patients (LHS and RHS, respectively) on the BELS-SC and standard executive function tests.

Eighty-eight acute/early sub-acute stroke patients and 116 age-matched healthy controls were included.

Principal Component Analysis (PCA) suggested four to five factors of the BELS-SC: Initiation, Selection, Inhibition (with strategy loading on Inhibition), Inhibition Response Time, and Semantic Retrieval Response Time. The BELS-SC had good sensitivity (.84) but poorer specificity (.66) differentiating controls and stroke, and good sensitivity (.83) and specificity (.80) differentiating executive function impaired versus executive function intact groups. BELS-SC Initiation and Inhibition subtests demonstrated convergent and divergent validity with corresponding Hayling subtests. LHS and RHS showed impairment across initiation, selection, inhibition and strategy; however, greatest deficits were shown by RHS on Inhibition items requiring suppression of one dominant response. More patients were impaired on BELS-SC than other executive function tests.

The BELS-SC demonstrated convergent, divergent, and construct validity, good sensitivity and specificity, taps multiple executive processes, and provides insight into strategy. Use in early stroke may aid in targeted and timely cognitive rehabilitation.

As the population ages, it is increasingly important to use effective short cognitive tests for suspected dementia. We aimed to review systematically brief cognitive tests for suspected dementia and report on their validation in different settings, to help clinicians choose rapid and appropriate tests.

Electronic search for face-to-face sensitive and specific cognitive tests for people with suspected dementia, taking ≤ 20 minutes, providing quantitative psychometric data.

22 tests fitted criteria. Mini-Mental State Examination (MMSE) and Hopkins Verbal Learning Test (HVLT) had good psychometric properties in primary care. In the secondary care settings, MMSE has considerable data but lacks sensitivity. 6-Item Cognitive Impairment Test (6CIT), Brief Alzheimer's Screen, HVLT, and 7 Minute Screen have good properties for detecting dementia but need further validation. Addenbrooke's Cognitive Examination (ACE) and Montreal Cognitive Assessment are effective to detect dementia with Parkinson's disease and Addenbrooke's Cognitive Examination-Revised (ACE-R) is useful for all dementias when shorter tests are inconclusive. Rowland Universal Dementia Assessment scale (RUDAS) is useful when literacy is low. Tests such as Test for Early Detection of Dementia, Test Your Memory, Cognitive Assessment Screening Test (CAST) and the recently developed ACE-III show promise but need validation in different settings, populations, and dementia subtypes. Validation of tests such as 6CIT, Abbreviated Mental Test is also needed for dementia screening in acute hospital settings.

Practitioners should use tests as appropriate to the setting and individual patient. More validation of available tests is needed rather than development of new ones.