Astrid Suchy-Dicey1,2, Clemma Muller1,2, Dean Shibata3, Barbara V Howard4, Shelley A Cole5, W T Longstreth6,7, Richard B Devereux8, Dedra Buchwald1,2. 1. Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA. 2. Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA. 3. Department of Radiology, University of Washington, Seattle, Washington, USA. 4. MedStar Health Research Institute, Hyattsville, Maryland, USA. 5. Texas Biomedical Research Institute, San Antonio, Texas, USA. 6. Department of Neurology, University of Washington, Seattle, Washington, USA. 7. Department of Epidemiology, University of Washington, Seattle, Washington, USA. 8. Weill Cornell Medical College, New York, New York, USA.
Abstract
BACKGROUND: Epidemiologic studies often use self-report as proxy for clinical history. However, whether self-report correctly identifies prevalence in minority populations with health disparities and poor health-care access is unknown. Furthermore, overlap of clinical vascular events with covert vascular brain injury (VBI), detected by imaging, is largely unexamined. METHODS: The Strong Heart Study recruited American Indians from 3 regions, with surveillance and adjudication of stroke events from 1989 to 2013. In 2010-2013, all 817 survivors, aged 65-95 years, underwent brain imaging, neurological history interview, and cognitive testing. VBI was defined as imaged infarct or hemorrhage. RESULTS: Adjudicated stroke was prevalent in 4% of participants and separately collected, self-reported stroke in 8%. Imaging-defined VBI was detected in 51% and not associated with any stroke event in 47%. Compared with adjudication, self-report had 76% sensitivity and 95% specificity. Participants with adjudicated or self-reported stroke had the poorest performance on cognitive testing; those with imaging-only (covert) VBI had intermediate performance. CONCLUSION: In this community-based cohort, self-report for prior stroke had good performance metrics. A majority of participants with VBI did not have overt, clinically recognized events but did have neurological or cognitive symptoms. Data collection methodology for studies in a resource-limited setting must balance practical limitations in costs, accuracy, feasibility, and research goals.
BACKGROUND: Epidemiologic studies often use self-report as proxy for clinical history. However, whether self-report correctly identifies prevalence in minority populations with health disparities and poor health-care access is unknown. Furthermore, overlap of clinical vascular events with covert vascular brain injury (VBI), detected by imaging, is largely unexamined. METHODS: The Strong Heart Study recruited American Indians from 3 regions, with surveillance and adjudication of stroke events from 1989 to 2013. In 2010-2013, all 817 survivors, aged 65-95 years, underwent brain imaging, neurological history interview, and cognitive testing. VBI was defined as imaged infarct or hemorrhage. RESULTS: Adjudicated stroke was prevalent in 4% of participants and separately collected, self-reported stroke in 8%. Imaging-defined VBI was detected in 51% and not associated with any stroke event in 47%. Compared with adjudication, self-report had 76% sensitivity and 95% specificity. Participants with adjudicated or self-reported stroke had the poorest performance on cognitive testing; those with imaging-only (covert) VBI had intermediate performance. CONCLUSION: In this community-based cohort, self-report for prior stroke had good performance metrics. A majority of participants with VBI did not have overt, clinically recognized events but did have neurological or cognitive symptoms. Data collection methodology for studies in a resource-limited setting must balance practical limitations in costs, accuracy, feasibility, and research goals.
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Authors: Astrid Suchy-Dicey; Dean Shibata; Brenna Cholerton; Lonnie Nelson; Darren Calhoun; Tauqeer Ali; Thomas J Montine; W T Longstreth; Dedra Buchwald; Steven P Verney Journal: J Int Neuropsychol Soc Date: 2019-12-03 Impact factor: 2.892
Authors: Astrid M Suchy-Dicey; Clemma J Muller; Tara M Madhyastha; Dean Shibata; Shelley A Cole; Jinying Zhao; W T Longstreth; Dedra Buchwald Journal: Am J Epidemiol Date: 2018-06-01 Impact factor: 4.897