Feasibility of Cognitive Functions Screened With the Montreal Cognitive Assessment in Determining ADL Dependence Early After Stroke

Abzhandadze, Tamar; Rafsten, Lena; Lundgren‐Nilsson, Åsa; Sunnerhagen, Katharina S.

doi:10.3389/fneur.2018.00705

Cited by 14 publications

(13 citation statements)

References 33 publications

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“…There are some strengths and limitations of the study. The research database comprises clinician-gathered data 2,15 ; thus, it can be assumed that the results have ecological validity. However, there were different assessors, which may have affected results on both the NIHSS and the MoCA.…”

Section: Discussionmentioning

confidence: 99%

“…The study sample consisted of people with stroke who were enrolled at the acute comprehensive stroke unit in Gothenburg, Sweden between May 2011 and April 2016 15 . The participants were screened for cognitive function and activities of daily living within the first two days after onset of stroke and included in the research database 2 . In total 2727 people were screened and 2474 received a stroke diagnosis.…”

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confidence: 99%

“…In total 2727 people were screened and 2474 received a stroke diagnosis. The complete data on the MoCA were available on 550 people 2 .…”

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confidence: 99%

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NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study

Abzhandadze

Reinholdsson

Sunnerhagen

2020

Sci Rep

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the aim of this study was to investigate whether the cognitive subscale of the national institute of Health Stroke Scale (NIHSS), the Cog-4, can detect cognitive deficits in acute stroke. This was a cross-sectional, retrospective study. The study sample consisted of people with stroke enrolled in an acute stroke unit. The index test Cog-4 was calculated based on admission NIHSS score. The reference standard instrument, the Montreal Cognitive Assessment (MoCA), was performed within 36-48 h of admission. Non-parametric statistics were used for data analyses. The study included 531 participants with a mean age of 69 years. The Cog-4 failed to identify cognitive deficits in 65%, 58%, and 53% of patients when the MocA thresholds for impaired cognition were set at ≤25 p, ≤23 p, and ≤19 p, respectively, were chosen for impaired cognition. The agreement between the Cog-4 and the MoCA was poor; cohen's kappa was from −0.210 to −0.109, depending on the MoCA cutoffs. The sensitivity of the Cog-4 was 35%, 42% and 48% for the MoCA thresholds for impaired cognition ≤25, ≤23 and ≤19 points, respectively. The Cog-4 has a limited ability to identify cognitive deficits in acute stroke. More structured and comprehensive tests should be employed as diagnostic tools. Cognitive difficulties are common manifestations during the acute phase of stroke and can persist after a seemingly successful neurological recovery affecting the daily lives of people who had a stroke 1,2. Cognitive deficits are linked with poor outcomes 3,4 ; thus, early identification of stroke-related cognitive impairments is important. Pinpointing the superior assessment tool for evaluating cognitive function after stroke is difficult 5. The National Institute of Health Stroke Scale (NIHSS) is a routinely used instrument for the assessment of stroke-related neurological deficits, but limited sensitivity for detecting cognitive deficits has been shown 6,7. However, Cumming et al. 8 suggested that the NIHSS subscale, the Cog-4, could be used to make a statement about cognition 8. The Cog-4 is estimated based on four items of the NIHSS-orientation, executive ability, language skills and extinction and inattention. The score range is 0-9 points, where 0 points indicates no cognitive deficits. Conflicting results have been reported regarding the capacity of Cog-4 to identify cognitive deficits after stroke 8-11. Some studies have reported that the Cog-4 cannot be considered a useful cognitive scale 9,10. Another study indicated that the Cog-4 is almost as good as other commonly used screening tools for cognition in patients with severe cognitive deficits 8. In these studies, the Cog-4 was compared with the Mini-Mental State Examination (MMSE) 8 , the Montreal Cognitive Assessment (MoCA) 10 , and follow-up assessment with the Cog-4 11. Assessments were performed within 1-4 days 10 , 90 days 9 , and 18 months 8 after stroke. It still remains unclear whether the Cog-4 can identify cognitive difficulties after stroke, especially very early after the onset of stroke. Cognitiv...

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NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study

Abzhandadze

Reinholdsson

Sunnerhagen

2020

Sci Rep

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“…Several studies have found that cognitive impairment after stroke was related to poor functional outcomes, but there were some methodological limitations: (I) most of the previous studies reported the functional status or the percentage of functional dependency among stroke patient at some special time points after onset, and few studies examined the trajectories (changes with time) of functional outcome after stroke (14,16,17). (II) Previous studies used cross-sectional design and explored the relationship between cognitive impairment and physical function at acute stage and at 3-6 months or 1-3 years after stroke onset (18)(19)(20)(21). Few studies had conducted longitudinal research and focused on the association between early cognitive impairment at acute stage of hospitalization and functional outcomes among stroke patients (16).…”

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confidence: 99%

Association Between Early Cognitive Impairment and Midterm Functional Outcomes Among Chinese Acute Ischemic Stroke Patients: A Longitudinal Study

Wang

et al. 2020

Front. Neurol.

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Background: Cognitive decline is common after stroke. The influence of early cognitive impairment on midterm functional outcomes among Chinese acute ischemic stroke (AIS) patients has not been fully studied. The aim of the study was to assess the association between early cognitive impairment and midterm functional outcomes among Chinese AIS patients. Methods: A longitudinal survey focusing on Chinese AIS patients was conducted in three stroke centers in Shanghai, China (July to December 2016). A total of 185 eligible patients were interviewed at acute stage and at 1, 3, and 6 months after onset. Patients' functional outcomes were measured by modified Rankin Scale (mRS) and Barthel Index (BI) at each time point. Cognitive function was assessed using Montreal Cognitive Assessment, Changsha version (MoCA-CS), within 7 days after stroke onset. Covariates included patient's demographic characteristics, socioeconomic status, clinical characteristics of stroke, vascular risk factors, receiving rehabilitation after discharge from acute hospital, and recurrence. Generalized linear mixed models and general linear mixed models were applied. Results: The prevalence of cognitive impairment at acute stage of stroke among these patients was 88.1%. The risk of disability (mRS 2-5) of all patients after stroke decreased over time (OR = 0.491, 95% CI = 0.401-0.603). The risk of disability among those with cognitive impairment increased compared with those with normal cognition (OR = 7.384, 95% CI = 1.041-52.407). The BI score of all patients increased over time after controlling for covariates (β = 1.51, p < 0.01). The BI score of those with cognitive impairment was lower than that with normal cognition over the follow-up period after controlling for other covariates (β = −8.11, p < 0.05). Li et al. Early Cognitive Impairment Predict Function Conclusions: This study showed that early cognitive impairment was associated with higher risk of disability and poor activity of daily living (ADL) among Chinese AIS patients. Further studies are needed to examine the linkage between multi-domain cognitive impairment and long-term disability and ADL among stroke survivors by using neuropsychological test batteries.

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“…Neurological impairment, older age, female sex, and previous stroke are well-known predictors of an increased need for help after stroke (2). Impaired cognition has also been associated with dependence (3, 4).…”

Section: Introductionmentioning

confidence: 99%

Very Early MoCA Can Predict Functional Dependence at 3 Months After Stroke: A Longitudinal, Cohort Study

et al. 2019

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Introduction: After a stroke, cognitive impairment is commonly associated with poor functional outcomes. The primary aim of this study was to investigate if cognitive function, assessed with the Montreal Cognitive Assessment (MoCA) 36–48 h after stroke, could predict functional dependence 3 months later. The secondary aim was to identify an optimal threshold for the MoCA score that could predict functional dependence.Materials and Methods: This was a longitudinal cohort study. The research database from a stroke unit at the Sahlgrenska University Hospital was linked with the Swedish Stroke Register—Riksstroke. Cognitive function and activities of daily living (ADL) were assessed with the MoCA and the Barthel Index (BI), respectively, 36–48 h after stroke. Functional outcome 3 months after stroke was studied with the modified Rankin Scale. The predictive characteristics of the MoCA were investigated using logistic regression analyses. Receiver operating characteristic curves (AUC) were used for identifying the optimal cutoff score on the MoCA for predicting functional dependence. The MoCA score that had equal sensitivity and specificity was chosen as the optimal score for predicting functional dependence.Results: A total of 305 participants were included in the study (mean age: 68.8 years, n = 179 men). The MoCA quartiles were a significant predictor of functional dependence 3 months after stroke as an individual variable (p < 0.001, AUC = 0.72) and when adjusted for covariates such as age at stroke onset, living arrangement prior to stroke, and ADL measured with BI within 36–48 h after stroke (p = 0.01, AUC = 0.84). The MoCA score of ≤23 for impaired cognition had equal sensitivity and specificity for predicting functional dependence 3 months after stroke.Discussion and Conclusion: Cognitive function assessed with the MoCA within 36–48 h after stroke could predict functional dependence 3 months later. The participants with MoCA scores ≤23 for impaired cognition were more likely to be functionally dependent.

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Feasibility of Cognitive Functions Screened With the Montreal Cognitive Assessment in Determining ADL Dependence Early After Stroke

Cited by 14 publications

References 33 publications

NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study

NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study

Association Between Early Cognitive Impairment and Midterm Functional Outcomes Among Chinese Acute Ischemic Stroke Patients: A Longitudinal Study

Very Early MoCA Can Predict Functional Dependence at 3 Months After Stroke: A Longitudinal, Cohort Study

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