Cognitive function testing
Cognitive function was assessed using two instruments: the Cognitive Failure Questionnaire (CFQ) and the Montreal Cognitive Assessment (MoCA) test. The CFQ is a subjective questionnaire that assesses the likelihood of committing errors in the completion of daily tasks such as the routines of everyday life.15 The CFQ consists of 25 items that are scored on a 5-point scale (range, 0 [never] to 4 [very often]). Thus, the total score ranges from 0-100, with higher scores indicating more frequently occurring cognitive failures. Women included in this study were instructed to complete the items with specific reference to the past 6 months prior to admission to hospital to assess the cognitive function prior to onset of pre-eclampsia. In the CFQ, there are 4 subscales that pertain to more specific areas of cognitive failures. These subscales are memory (7 items; range, 0-28), distractibility (9 items; range, 0-36), blunders (7 items; range, 0-28) and names (2 items; range, 0-8).15
The MoCA test is an objective assessment composed of a variety of cognitive domains assessing attention, concentration, executive function, memory, language, visio-spatial abilities, abstract thinking, mathematical calculations and orientation.16 The highest possible score is 30 points and a score of 26 points or greater indicates normal function in individuals with a total school education of more than 12 years. If total school education is less than 12 years, an additional point is added to the total score.16
The assessments were administered by trained research midwives and a trained medical student. All assessments were performed postpartum, as close to discharge as possible, to avoid situations where women could have been too tired or sick to perform adequately. The CFQ test was available in English and Afrikaans and questions were translated to Xhosa by an interpreter. The MoCA test was available in English and Afrikaans and performed in Xhosa if needed at time of assessment by the Xhosa speaking research midwife. Translations to Xhosa from English for both the CFQ test and the MoCa test were checked for accuracy during the first five tests in order to control that the women understood the questions correctly and to secure validity.