Effectively capturing memory deficits: New advances in the use of the In-out-Test for cognitive Test post-stroke

Objective: This study evaluated the reliability and validity of the In-Out-Test for detecting episodic memory deficits in stroke patients and explored its potential as a clinical test.

Methods: A total of 75 stroke patients and 120 healthy controls underwent tests, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Picture-Based Memory Impairment Screen (PMIS), and In-Out-Test. Reliability metrics (Cronbach's α, inter-scorer reliability, test-retest reliability), criterion validity, corrected item-total correlation, hierarchical regression analysis and ROC curve analysis were performed to determine the sensitivity and specificity of the In-Out-Test.

Results: Stroke patients scored lower across all tests (p < 0.001), with the largest difference in the In-Out-Test (d = 0.99). The In-Out-Test correlated strongly with other cognitive tests (r = 0.79-0.85 in stroke patients; r = 0.66-0.78 in controls). It explained an additional 4.5% of variance in MoCA-MIS scores (p < 0.001). Reliability was high (Cronbach's α = 0.835; inter-rater ICCs = 0.911-0.925; test-retest ICCs = 0.764-0.802). ROC analysis showed an AUC of 0.747, with a sensitivity of 0.708 and specificity of 0.680 at a cutoff of 10.5.

Conclusion: Preliminary findings indicated that the In-Out-Test showed potential in detecting episodic memory impairments in stroke patients, warranting further validation in larger cohorts.