Screening for cognitive impairment after stroke: A systematic review of psychometric properties and clinical utility

Burton, Louisa-Jane; Tyson, Sarah

doi:10.2340/16501977-1930

Cited by 157 publications

(126 citation statements)

References 59 publications

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“…The Montreal Cognitive Assessment (MoCA) is a recommended tool for assessing cognitive functions in patients with acute stroke (3, 4). Good validity and reliability were reported for those with mild to moderate stroke (4).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Objective: To investigate the feasibility of assessing cognitive function using the Montreal Cognitive Assessment (MoCA) given 36–48 h post stroke to explain dependence in activities of daily living (ADL).Methods: This is a cross-sectional, exploratory study. Cognitive function and basic ADL were assessed with the MoCA and the Barthel Index (BI), respectively, within 36–48 h of admission. Neurological functions were assessed with the National Institute of Health Stroke Scale (NIHSS) upon admittance to the hospital. Binary logistic regression analyses were performed to assess the feasibility of the MoCA in explaining ADL dependence.Results: Data were available for 550 patients (42% females, mean age 69 years). Moderate correlations (rs > +0.30, p < 0.001) were found between the total score on the BI, MoCA, and visuospatial/executive functions. The regression analysis model including only MoCA as an independent variable had a high sensitivity for explaining ADL dependence. However, the model with independent variables of MoCA, NIHSS, and age had the best area under the curve value (0.74).Conclusions: Cognitive functions assessed with the MoCA partly explain ADL dependence 36–48 h post stroke. Stroke-related neurological deficits and age should be additional considerations.

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Section: Introductionmentioning

confidence: 99%

“…Good validity and reliability were reported for those with mild to moderate stroke (4). Studies performed on a subacute stroke population showed a positive association between impaired cognitive function assessed with the MoCA and a high level of global disability (5).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…The MoCA has good psychometric properties and is a valid screening tool to detect post-stroke cognitive impairment [13]. Although a recent study [14] questioned the accuracy of the MoCA to assess attention and executive function by stroke lateralization, the majority of studies have shown the MoCA to be superior compared to other screening measures such as the MMSE [11, 15, 16].…”

Section: Assessmentmentioning

confidence: 99%

Determinants, Prevalence, and Trajectory of Long-Term Post-Stroke Cognitive Impairment: Results from a 4-Year Follow-Up of the ARCOS-IV Study

et al. 2017

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Background: The long-term (>12 months) prevalence, predictors, and trajectory of post-stroke cognitive deficits are not well established, especially at a community level. This study investigated the longitudinal course and prevalence of cognitive impairment in an incidence cohort, identifying factors associated with declining cognition. Methods: Two hundred fifty-seven participants (mean age = 67.93 ± 13.59) of first-ever stroke survivors, completed cognitive assessments within 2 weeks post stroke, and/or 1, 6, 12, and 48-month. Multivariate linear and logistic models were used to identify baseline predictors (reported as OR with 95% CI) and trajectory of cognitive impairment. Results: Cognitive functioning significantly declined by 2.8 points by 4 years post stroke. Eighty-four percent of stroke survivors had cognitive impairment indicative of post-stroke dementia (mean Montreal cognitive assessment = 20 ± 4.7) at 4-year. There were significant associations between progressive cognitive decline and the following factors: male gender (OR 2.9, 95% CI 1.6–5.9, p = 0.0171), coronary artery disease (OR 2.96, 95% CI 1.35–6.49, p = 0.0070), arrhythmia (OR 2.21, 95% CI 1.07–4.57, p = 0.0317), not in a relationship (OR 2.8, 95% CI 1.4–5.50, p < 0.0001), and not employed (OR 4.9, 95% CI 1.9–12.1, p < 0.0001). Conclusions: Cognitive deficits remain highly prevalent at 4-year post stroke. Early identification of those at higher risk of declining cognition is vital to target rehabilitation interventions at the acute stage and improve overall outcomes.

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“…13 According to recent reviews, the MoCA is the most sensitive screening tool in detecting poststroke cognitive impairment without a ceiling effect. [14][15][16] To date, there are only a few studies that used the MoCA to assess changes in cognitive performance at repeated time points after stroke. [17][18][19] Two studies showed that MoCA scores improved in transient ischemic attack and stroke patients from baseline until 3-month follow-up.…”

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confidence: 99%

Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment

Nijsse

Visser-Meily

Mierlo

et al. 2017

Stroke

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One of these studies compared cognitively impaired stroke patients (MoCA <26) who improved by ≥2 MoCA points, called reverters, to those who did not improve by ≥2 points. Factors associated with reverter status were older age and more severe stroke symptoms at baseline. 17 Determinants ofBackground and Purpose-The Montreal Cognitive Assessment (MoCA) is nowadays recommended for the screening of poststroke cognitive impairment. However, little is known about the temporal evolution of MoCA-assessed cognition after stroke. The objective of this study was to examine the temporal pattern of overall and domain-specific cognition at 2 and 6 months after stroke using the MoCA and to identify patient groups at risk for cognitive impairment at 6 months after stroke. Methods-Prospective cohort study in which 324 patients were administered the MoCA at 2 and 6 months post stroke.Cognitive impairment was defined as MoCA<26. Differences in cognitive impairment rates between 2 and 6 months post stroke were analyzed in different subgroups. Patients with MoCA score <26 at 2 months, who improved by ≥2 points by 6 months, were defined as reverters. Logistic regression analyses were used to identify determinants of (1) cognitive impairment at 6 months post stroke and (2) reverter status. Results-Between 2 and 6 months post stroke, mean MoCA score improved from 23.7 (3.9) to 24.7 (3.5), P<0.001. Prevalence of cognitive impairment at 2 months was 66.4%, compared with 51.9% at 6 months (P<0.001). More comorbidity and presence of cognitive impairment at 2 months were significant independent predictors of cognitive impairment 6 months post stroke. No significant determinants of reverter status were identified. Conclusions-Although cognitive improvement is seen ≤6 months post stroke, long-term cognitive deficits are prevalent.Identifying patients at risk of cognitive impairment is, therefore, important as well as targeting interventions to this group.

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Screening for cognitive impairment after stroke: A systematic review of psychometric properties and clinical utility

Abstract: The MoCA is the most valid and clinically feasible screening tool to identify stroke survivors with a wide range of cognitive impairments who warrant further assessment.

Cited by 157 publications

References 59 publications

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

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

Determinants, Prevalence, and Trajectory of Long-Term Post-Stroke Cognitive Impairment: Results from a 4-Year Follow-Up of the ARCOS-IV Study

Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment

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