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Christiane Reitz, MD, PhD; Nicole Schupf, PhD; José A. Luchsinger, MD, MPH; Adam M. Brickman, PhD; Jennifer J. Manly, PhD; Howard Andrews, PhD; Ming X. Tang, PhD; Charles DeCarli, PhD; Truman R. Brown, PhD; Richard Mayeux, MD, MSc

Arch Neurol. 2009;66(7):834-840. Published online May 11, 2009 (doi:10.1001/archneurol.2009.83).

Background  The validity of a self-reported stroke remains inconclusive.

Objective  To validate the diagnosis of self-reported stroke using stroke identified by magnetic resonance imaging (MRI) as the standard.

Design, Setting, and Participants  Community-based cohort study of nondemented, ethnically diverse elderly persons in northern Manhattan.

Methods  High-resolution quantitative MRIs were acquired for 717 participants without dementia. Sensitivity and specificity of stroke by self-report were examined using cross-sectional analyses and the ² test. Putative relationships between factors potentially influencing the reporting of stroke, including memory performance, cognitive function, and vascular risk factors, were assessed using logistic regression models. Subsequently, all analyses were repeated, stratified by age, sex, ethnic group, and level of education.

Results  In analyses of the whole sample, sensitivity of stroke self-report for a diagnosis of stroke on MRI was 32.4%, and specificity was 78.9%. In analyses stratified by median age (80.1 years), the validity between reported stroke and detection of stroke on MRI was significantly better in the younger than the older age group (for all vascular territories: sensitivity and specificity, 36.7% and 81.3% vs 27.6% and 26.2%; P = .02). Impaired memory, cognitive skills, or language ability and the presence of hypertension or myocardial infarction were associated with higher rates of false-negative results.

Conclusions  Using brain MRI as the standard, specificity and sensitivity of stroke self-report are low. Accuracy of self-report is influenced by age, presence of vascular disease, and cognitive function. In stroke research, sensitive neuroimaging techniques rather than stroke self-report should be used to determine stroke history.

Author Affiliations: Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Drs Reitz, Schupf, Luchsinger, Brickman, Manly, and Mayeux), Departments of Neurology (Drs Luchsinger, Brickman, Manly, and Mayeux), Psychiatry (Drs Schupf and Mayeux), Medicine (Dr Luchsinger), and Radiology (Dr Brown), and Gertrude H. Sergievsky Center (Drs Reitz, Schupf, Brickman, Manly, Tang, and Mayeux), College of Physicians and Surgeons; Departments of Epidemiology (Drs Schupf, Luchsinger, and Mayeux) and Biostatistics (Drs Andrews and Tang), Joseph P. Mailman School of Public Health; and Department of Biomedical Engineering (Dr Brown), Columbia University, New York, New York; and Department of Neurology and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California, Davis (Dr DeCarli).

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