Background: Neuropsychological screening becomes increasingly important for the evaluation of subarachnoid hemorrhage (SAH) and stroke patients. It is often performed during the surveillance period on the intensive (ICU), while it remains unknown, whether the distraction in this environment influences the results. We aimed to study the reliability of the Montreal Cognitive Assessment (MoCA) in the ICU environment. Methods: Consecutive stable patients with recent brain injury (tumor, trauma, stroke, etc.) were evaluated twice within 36 h using official parallel versions of the MoCA (ΔMoCA). The sequence of assessment was randomized into (a) busy ICU first or (b) quiet office first with subsequent crossover. For repeated MoCA, we determined sequence, period, location effects, and the intraclass correlation coefficient (ICC). Results: N = 50 patients were studied [ n = 30 (60%) male], with a mean age of 57 years. The assessment's sequence [“ICU first” mean ΔMoCA −1.14 (SD 2.34) vs. “Office first” −0.73 (SD 1.52)] did not influence the MoCA ( p = 0.47). On the 2nd period, participants scored 0.96 points worse (SD 2.01; p = 0.001), indicating no MoCA learning effect but a possible difference in parallel versions. There was no location effect ( p = 0.31) with ΔMoCA between locations (Office minus ICU) of −0.32 (SD 2.21). The ICC for repeated MoCA was 0.87 (95% CI 0.79–0.92). Conclusions: The reliability of the MoCA was excellent, independent from the testing environment being ICU or office. This finding is helpful for patient care and studies investigating the effect of a therapeutic intervention on the neuropsychological outcome after SAH, stroke or traumatic brain injury.

Background Although most aneurysmal subarachnoid hemorrhage (aSAH) patients suffer from neuropsychological disabilities, outcome estimation is commonly based only on functional disability scales such as the modified Rankin Scale (mRS). Moreover, early neuropsychological screening tools are not used routinely. Objective To study whether two simple neuropsychological screening tools identify neuropsychological deficits (NPDs), among aSAH patients categorized with favorable outcome (mRS 0-2) at discharge. Methods We reviewed 170 consecutive aSAH patients that were registered in a prospective institutional database. We included all patients graded by the mRS at discharge, and who had additionally been evaluated by a neuropsychologist and/or occupational therapist using the Montreal Cognitive Assessment (MoCA) and/or Rapid Evaluation of Cognitive Function (ERFC). The proportion of patients with scores indicative of NPDs in each test were reported, and spearman correlation tests calculated the coefficients between the both neuropsychological test results and the mRS. Results Of the 42 patients (24.7%) that were evaluated by at least one neuropsychological test, 34 (81.0%) were rated mRS 0-2 at discharge. Among these 34 patients, NPDs were identified in 14 (53.9%) according to the MoCA and 8 (66.7%) according to the ERFC. The mRS score was not correlated with the performance in the MoCA or ERFC. Conclusion The two screening tools implemented here frequently identified NPDs among aSAH patients that were categorized with favorable outcome according to the mRS. Our results suggest that MoCA or ERFC could be used to screen early NPDs in favorable outcome patients, who in turn might benefit from early neuropsychological rehabilitation.

Clinical observations suggest dynamic alterations in behavior after brain surgery. While some alterations reportedly occur within days others gradually develop over several months. These alterations can be attributed to the pre-surgical impact of the diseased tissue, neuronal damage caused by the surgery, and subsequent plasticity. A key step towards a systems-level understanding of the brain-behavior relationships is to capture the dynamics of the cognitive alterations. Here, we first established in 38 healthy individuals that the day-to-day smartphone interactions can be used to inform on cognitive processing speed. Next, we analyzed the smartphone interactions in 12 patients undergoing intracranial tumor surgery, with postsurgical follow-up of up to a year. In healthy individuals, the speed of the touchscreen interactions was highly correlated to choice reaction times (R2 = 0.71) but less so to simple reaction times (R2 = 0.15) on Deary-Liewald tests. Touchscreen interactions slowed immediately after surgery but the post-surgical changes varied between patients. Data-driven models revealed the time-constant of the short-term postsurgical changes and the time taken to stabilize after the surgery. Furthermore, by using conceptually distinct types of touchscreen interaction speeds – i.e. unlocking time and app locating speed – we established that the post-surgical changes are domain-specific. Interestingly, in this small sample, the pre-surgical smartphone speeds were highly related to the speeds post-stabilization (R2 = 0.75 to 0.95). The proxy measures of cognition seamlessly captured on the smartphone can reveal postsurgical dynamics inaccessible to conventional testing. We propose that the transient cognitive alterations indicate the time-constrained influence of distinct neuronal mechanisms triggered by the surgery.