Early Post-stroke Cognition: In-hospital Predictors and the Association With Functional Outcome
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Purpose: To characterize and predict early post-stroke cognitive impairment by describing cognitive changes in stroke patients 4–8 weeks post-infarct, determining the relationship between cognitive ability and functional status at this early time point, and identifying the in-hospital risk factors associated with early dysfunction. Materials and Methods: Data were collected for 214 patients with ischemic stroke and 39 non-stroke controls. Montreal Cognitive Assessment (MoCA) exams were administered at post-hospitalization clinic visits approximately 4–8 weeks after infarct. MoCA scores were compared for patients with: no stroke, minor stroke [NIH Stroke Scale (NIHSS) < 5], and major stroke. Ordinal logistic regression was performed to assess the relationship between MoCA score and functional status [modified Rankin Scale score (mRS)] at follow-up. Predictors of MoCA < 26 and < 19 (cutoffs for mild and severe cognitive impairment, respectively) at follow-up were identified by multivariable logistic regression using variables available during hospitalization. Results: Post stroke cognitive impairment was common, with 66.8% of patients scoring < 26 on the MoCA and 22.9% < 19. The average total MoCA score at follow-up was 18.7 (SD 7.0) among major strokes, 23.6 (SD 4.8) among minor strokes, and 27.2 (SD 13.0) among non-strokes ( p = <0.0001). The follow-up MoCA score was associated with the follow-up mRS in adjusted analysis (OR 0.69; 95% C.I. 0.59–0.82). Among patients with no prior cognitive impairment ( N = 201), a lack of pre-stroke employment, admission NIHSS > 6, and left-sided infarct predicted a follow-up MoCA < 26 (c-statistic 0.75); while admission NIHSS > 6 and infarct volume > 17 cc predicted a MoCA < 19 (c-statistic 0.75) at follow-up. Conclusion: Many patients experience early post-stroke cognitive dysfunction that significantly impacts function during a critical time period for decision-making regarding return to work and future independence. Dysfunction measured at 4–8 weeks can be predicted during the inpatient hospitalization. These high-risk individuals should be identified for targeted rehabilitation and counseling to improve longer-term post-stroke outcomes.Keywords:
Montreal Cognitive Assessment
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The Montreal Cognitive Assessment (MoCA) is one of the most common screening instruments for mild cognitive impairment. However, the standard MoCA is approximately two times longer to administer than the Mini-Mental State Examination. A total of 699 Czech and 175 American participants received the standard MoCA Czech and English versions and in the clinical part, a sample of 102 nondemented patients with Parkinson's disease (PD). We created a validated Czech short version (s-MoCA-CZ) from the original using item response theory. As expected, s-MoCA-CZ scores were highly correlated with the standard version (Pearson
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Objective To study the effect of Motreal cognitive assessment(MoCA)(Chinese version) in diagnosing the amnestic mild cognitive impairment.Methods A total of 61 persons were chosen from the outpatient section of Beijing Hospital(2009-05-2010-03),including 31 patients who meeting the criteria of MCI-Revised(MCI-R) and 30 normal controls(NC) for comparing the sensitivity and specificity of the mini-mental state examination(MMSE) and MoCA in diagnosing the aMCI and analysing the effect and characteristics of MoCA in diagnosing the aMCI.Results When using the cut off score of 26,the sensitivity of MMSE and MoCA are 9.68% and 87.10% separately,the specificity are 93.33% and 73.33%.Conclusions MoCA might play an important role in screening aMCI and the other cognitive impairments due to the better sensitivity of MoCA and its wide cover of multiple cognitive district.
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The Montreal Cognitive Assessment (MoCA) is known to have discriminative power for patients with Mild Cognitive Impairment (MCI). Recently Cognitive Reserve (CR) has been introduced as a factor that compensates cognitive decline. We aimed to assess whether the MoCA reflects CR. Furthermore, we assessed whether there were any differences in the efficacy between the MoCA and the Mini-Mental State Examination (MMSE) in reflecting CR. MoCA, MMSE, and the Cognitive Reserve Index questionnaire (CRIq) were administered to 221 healthy participants. Normative data and associated factors of the MoCA were identified. Correlation and regression analyses of the MoCA, MMSE and CRIq scores were performed, and the MoCA score was compared with the MMSE score to evaluate the degree to which the MoCA reflected CR. The MoCA reflected total CRIq score (CRI; B = 0.076, P < 0.001), CRI-Education (B = 0.066, P < 0.001), and CRI-Working activity (B = 0.025, P = 0.042), while MMSE reflected total CRI (B = 0.044, P < 0.001) and CRI-Education (B = 0.049, P < 0.001) only. The MoCA differed from the MMSE in the reflection of total CRI (Z = 2.30). In this study, we show that the MoCA score reflects CR more sensitively than the MMSE score. Therefore, we suggest that MoCA can be used to assess CR and early cognitive decline.
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The Montreal Cognitive Assessment （MoCA） は軽度認知障害のスクリーニング検査であり，合計得点の算出時に教育年数を考慮する特徴がある。先行研究では，MoCAの下位指標の一つである言語領域得点において教育年数の影響が報告されているが，日本においてMoCAの各認知領域得点と教育年数との関連は明らかになっていない。そこで本研究では，教育年数がMoCAの各認知領域に与える影響を評価するため，60歳以上の健常高齢者104名に対し日本語版MoCAおよび教育年数の聴取を行い，教育年数で2群（低群：12年以下，37名；高群：13年以上，67名）に分け，各認知領域得点についてWelch’s t-testを行った。その結果，先行研究で報告されている言語領域得点（t（76.0）＝－2.114, p＝0.038）に加え，注意領域得点（t（62.8）＝－2.075, p＝0.042）においても，教育年数高群の方が低群よりも有意に高かった。以上より，日本では教育年数がMoCAの言語領域だけでなく注意領域にも影響を与えることが示唆された。
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Objective To investigate the feasibility of application of Montreal Cognitive Assessment Scale(MoCA) chinese version to the assessment of global cognition in the patients with vascular mild cognitive impairment(vMCI).Methods Fifty vMCI patients and fifty healthy normal subjects were included in the study.Their cognitive functions were assessed with MoCA and Mini-Mental State Examination(MMSE),and the results were analyzed and compared.Results There was a significant correlation between the MMSE and the MoCA scores in both groups(P0.05),and MoCA scores were significantly lower than MMSE scores(P0.05).The significant differences presented between vMCI group and control group in the comparison of sub-item score and total score in MoCA.The MoCA had the sensitivity of 84.0% and the specificity of 76.0% for detecting vMCI,the sensitivity and the specificity of MMSE was 46.0% and 98%,respectively.Conclusion The MoCA has higher sensitivity than the MMSE for cognitive assessment in the patients with vMCI.
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The Montreal Cognitive Assessment (MoCA; Nasreddine et al., JAGS 2005) is a brief measure of global cognitive function used worldwide and validated as a reliable tool for the detection of cognitive impairment in several neurodegenerative diseases and medical conditions. Our objective was to investigate the validity of the German MoCA alternate forms for the purpose of longitudinal clinical and research applications.
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