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.