Brief screening tests during acute admission in patients with mild stroke are predictive of vascular cognitive impairment 3–6 months after stroke

Dong, Yi; Venketasubramanian, Narayanaswamy; Chan, Bernard; Sharma, Vijay K.; Slavin, Melissa J.; Collinson, Simon L.; Sachdev, Perminder S.; Chan, Yiong Huak; Chen, Christopher

doi:10.1136/jnnp-2011-302070

Cited by 94 publications

(104 citation statements)

References 37 publications

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“…15 To establish the prognostic value of MoCA, 3 studies compared MoCA performances in the acute/subacute poststroke period with those on extensive neuropsychological batteries at midterm follow-up. 12,17,20 These studies showed that baseline MoCA can predict the development of PSCI at 3, 6, and 12 months with an accuracy of ≥90%. In our study, MoCA baseline score was an independent determinant of PSCI with an odds ratio 1.4 for each test point lost.…”

Section: Strokementioning

confidence: 99%

“…shown in some Asian and European studies 11,16,17 ; some of these studies found a threshold of 6 years of education for adding 1 point to MoCA total score. 28,36 Another methodological problem when selecting the optimal cut-off score for MoCA normality is the choice of the thresholds to define cognitive impairment in the gold standard.…”

Section: October 2014mentioning

confidence: 99%

“…10,11,14,[16][17][18][19] These exclusion criteria led to apply MoCA mostly in mild-to-moderate patients with stroke, usually with first-ever ischemic stroke, without other major disorders or severe aphasia. The fact that patients with severe neurological status or aphasia cannot be tested with MoCA is not necessarily a major limitation of this tool because these patients are already candidates for specific rehabilitation programs or long-term care strategies.…”

Section: Strokementioning

confidence: 99%

“…attack, 8,[10][11][12][13] hemorrhages, 10,14 severe stroke, 15 major physical disability, 14,[16][17][18] significant aphasia, 8,10,11,13,[16][17][18] inability to participate in rehabilitation activities, 8 prestroke cognitive impairment, [15][16][17] acute delirium, 17 and major psychiatric disorder. 10,11,14,[16][17][18][19] These exclusion criteria led to apply MoCA mostly in mild-to-moderate patients with stroke, usually with first-ever ischemic stroke, without other major disorders or severe aphasia.…”

Section: Strokementioning

confidence: 99%

“…11 Similarly, Lees et al, 33 using the original cut-off of 26, diagnosed cognitive impairments in 86% of acute stroke unit patients; the proportion decreased to 49% if the cut-off was decreased to 20. Most studies found that the cut-off of 26, suggested by Nasreddine et al 5 to detect MCI in a memory clinic, is inadequate for the stroke setting. The optimal values for normality range from 19 to 22 in studies in which MoCA was administered in the acute stroke phase, 11,12,17,20 and from 20 to 27 in studies in which the test was administered in the chronic phase, 24,27,28,30,[34][35][36] once performances were compared with those on extensive batteries at follow-up.…”

Section: Use Of Moca In the Chronic Poststroke Phasementioning

confidence: 99%

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Use of Montreal Cognitive Assessment in Patients With Stroke

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Section: Strokementioning

confidence: 99%

Section: October 2014mentioning

confidence: 99%

Section: Strokementioning

confidence: 99%

Section: Strokementioning

confidence: 99%

Section: Use Of Moca In the Chronic Poststroke Phasementioning

confidence: 99%

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Use of Montreal Cognitive Assessment in Patients With Stroke

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Pantoni

2014

Stroke

135

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Abnormalities of cortical thickness, subcortical shapes, and white matter integrity in subcortical vascular cognitive impairment

Thong

Ratnarajah

et al. 2013

Human Brain Mapping

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Subcortical vascular cognitive impairment (sVCI) is caused by lacunar infarcts or extensive and/or diffuse lesions in the white matter that may disrupt the white matter circuitry connecting cortical and subcortical regions and result in the degeneration of neurons in these regions. This study used structural magnetic resonance imaging (MRI) and high angular resolution diffusion imaging (HARDI) techniques to examine cortical thickness, subcortical shapes, and white matter integrity in mild vascular cognitive impairment no dementia (VCIND Mild) and moderate-to-severe VCI (MSVCI). Our study found that compared to controls (n = 25), VCIND Mild (n = 25), and MSVCI (n = 30) showed thinner cortex predominantly in the frontal cortex. The cortex in MSVCI was thinner in the parietal and lateral temporal cortices than that in VCIND Mild. Moreover, compared to controls, VCIND Mild and MSVCI showed smaller shapes (i.e., volume reduction) in the thalamus, putamen, and globus pallidus and ventricular enlargement. Finally, compared to controls, VCIND Mild, and MSVCI showed an increased mean diffusivity in the white matter, while decreased generalized fractional anisotropy was only found in the MSVCI subjects. The major axonal bundles involved in the white matter abnormalities were mainly toward the frontal regions, including the internal capsule/corona radiata, uncinate fasciculus, and anterior section of the inferior fronto-occipital fasciculus, and were anatomically connected to the affected cortical and subcortical structures. Our findings suggest that abnormalities in cortical, subcortical, and white matter morphology in sVCI occur in anatomically connected structures, and that abnormalities progress along a similar trajectory from the mild to moderate and severe conditions.

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Predictive value of MoCA in the acute phase of stroke on the diagnosis of mid-term cognitive impairment

et al. 2013

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Post-stroke cognitive impairment (PSCI) includes all forms of cognitive decline that develop after stroke, even if not severe enough to fit the criteria of dementia. Our aims were to investigate the predictive value of a brief bedside examination (Montreal Cognitive Assessment, MoCA) in the acute phase of stroke on the diagnosis of mid-term PSCI, taking into account other clinical, cognitive, functional, and neuroimaging predictors. Consecutive patients admitted to a stroke unit were evaluated with MoCA between 5 and 9 days after stroke. At baseline, clinical, functional, and neuroimaging data were collected. Patients were reassessed between 6 and 9 months after stroke by means of an extensive neuropsychological and functional evaluation. Out of 137 enrolled stroke patients, 80 (58.4%) were followed up (mean age 68.2 ± 14.6 years, males 66%, mean NIHSS score 3.6 ± 4.8). PSCI was diagnosed in 47 patients (59%; 35 mild cognitive impairment, 12 dementia). Controlling for age, education, functional and cognitive pre-morbid status, stroke severity, and pre-existing lacunar infarcts, MoCA baseline score [OR (95% CI) = 1.4(1.1-1.8)] for each point] and leukoaraiosis severity [OR (95% CI) = 0.4(0.2-0.9)] for each point of the van Swieten scale] were independently associated with PSCI. Using a ROC analysis, a cut-off of 21 predicted the diagnosis of PSCI with 91.4 % sensitivity, 75.8 % specificity, 80 % positive predictive value, and 89.3 % negative predictive value. In a sample of mild stroke patients, MoCA seems to be a good predictor of mid-term PSCI, making it a possible candidate for a brief cognitive screening in the acute stroke setting.

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Brief screening tests during acute admission in patients with mild stroke are predictive of vascular cognitive impairment 3–6 months after stroke

Abstract: Brief screening tests during acute admission in patients with mild stroke are predictive of significant vascular cognitive impairment 3-6 months after stroke.

Cited by 94 publications

References 37 publications

Use of Montreal Cognitive Assessment in Patients With Stroke

Use of Montreal Cognitive Assessment in Patients With Stroke

Abnormalities of cortical thickness, subcortical shapes, and white matter integrity in subcortical vascular cognitive impairment

Predictive value of MoCA in the acute phase of stroke on the diagnosis of mid-term cognitive impairment

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