Self-perceptions on cognitive versus motor disability among neurologists

  • Shahed Toossi
  • Konrad H. Schlick
  • Shouri LahiriEmail author
Original Article



The modified Rankin Scale is a functional outcome measure that disproportionately represents motor deficits. We hypothesize that among physicians who most commonly use the modified Rankin Scale to counsel patients on neurological treatment options, personal perception of acceptable or optimal outcome may be discordant with those described in clinical trials.


A three-question anonymous voluntary survey was emailed to academic and community practicing neurologists and board-eligible or board-certified neurology fellows inquiring about their personal perception of a better quality of life between two choices featuring clinical scenarios that would qualify as modified Rankin Scale 2 and 4 disability outcome scores.


Sixty-nine percent of participants were 30–45 years old, 24% were 45–60 years old, and 7% were over 60 years old. Most responders were general neurologists (31.3%). The remaining responders represented multiple subspecialties including neurocritical care, vascular neurology, neurohospitalist medicine, neuromuscular neurology, neurophysiology, child neurology, neuro-oncology, headache, neuroimmunology, movement disorders, and palliative care medicine. Forty-four of 45 neurologists (97.7%) stated they would choose needing a wheelchair if still able to function at their cognitive baseline at work (p < 0.000001). One responder preferred to get around without assistance, despite new cognitive symptoms that would preclude them from working as a physician.


The modified Rankin Scale may not adequately represent preferred outcomes among neurology specialists, particularly with respect to cognitive symptoms. Future studies are needed to characterize long-term cognitive outcomes in patients with acute stroke-related conditions.


Stroke Cognitive outcomes Stroke disability Cognitive function after stroke 


Compliance with ethical standards

Conflict of interest



  1. 1.
    Banks JL, Marotta CA (2007) Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke 38(3):1091–1096. CrossRefPubMedGoogle Scholar
  2. 2.
    Sulter G, Steen C, De Keyser J (1999) Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke 30(8):1538–1541CrossRefGoogle Scholar
  3. 3.
    van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19(5):604–607CrossRefGoogle Scholar
  4. 4.
    Uyttenboogaart M, Stewart RE, Vroomen PC, De Keyser J, Luijckx GJ (2005) Optimizing cutoff scores for the Barthel index and the modified Rankin scale for defining outcome in acute stroke trials. Stroke 36(9):1984–1987. CrossRefPubMedGoogle Scholar
  5. 5.
    Katzan IL, Thompson NR, Uchino K, Lapin B (2018) The most affected health domains after ischemic stroke. Neurology. CrossRefGoogle Scholar
  6. 6.
    Salihovic D, Smajlovic D, Mijajlovic M, Zoletic E, Ibrahimagic OC (2018) Cognitive syndromes after the first stroke. Neurol Sci 39(8):1445–1451. CrossRefPubMedGoogle Scholar
  7. 7.
    Jokinen H, Melkas S, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, Hietanen M (2015) Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol 22(9):1288–1294. CrossRefPubMedGoogle Scholar
  8. 8.
    Scott RB, Eccles F, Molyneux AJ, Kerr RS, Rothwell PM, Carpenter K (2010) Improved cognitive outcomes with endovascular coiling of ruptured intracranial aneurysms: neuropsychological outcomes from the international subarachnoid aneurysm trial (ISAT). Stroke 41(8):1743–1747. CrossRefPubMedGoogle Scholar
  9. 9.
    Appelros P, Samuelsson M, Lindell D (2005) Lacunar infarcts: functional and cognitive outcomes at five years in relation to MRI findings. Cerebrovasc dis (Basel, Switzerland) 20(1):34–40. CrossRefGoogle Scholar
  10. 10.
    Cella D, Lai JS, Nowinski CJ, Victorson D, Peterman A, Miller D, Bethoux F, Heinemann A, Rubin S, Cavazos JE, Reder AT, Sufit R, Simuni T, Holmes GL, Siderowf A, Wojna V, Bode R, McKinney N, Podrabsky T, Wortman K, Choi S, Gershon R, Rothrock N, Moy C (2012) Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology. Neurology 78(23):1860–1867. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Gershon RC, Wagster MV, Hendrie HC, Fox NA, Cook KF, Nowinski CJ (2013) NIH toolbox for assessment of neurological and behavioral function. Neurology 80(11 Suppl 3):S2–S6. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Departments of Neurology and NeurosurgeryCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of NeurologyCedars-Sinai Medical CenterLos AngelesUSA
  3. 3.Departments of Neurology, Neurosurgery, and Biomedical SciencesCedars-Sinai Medical CenterLos AngelesUSA

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