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Vascular cognitive impairment: most useful subtests of the Montreal Cognitive Assessment in minor stroke and
Christian Bocti1, Véronique Legault, Nancy Leblanc
1Division of Neurology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Que., Canada.
Insights
The Montreal Cognitive Assessment (MoCA) effectively identifies cognitive impairment in mild cerebrovascular disease, predicting functional outcomes. A brief 5-subtest version shows high accuracy for detecting vascular cognitive impairment.
Area of Science:
- Neurology
- Neuropsychology
- Geriatrics
Background:
- Cognitive impairment is common in cerebrovascular disease but often overlooked.
- The Montreal Cognitive Assessment (MoCA) is a potential tool for detecting this impairment.
- Previous research has focused on more severe stroke cases.
Purpose of the Study:
- To evaluate the Montreal Cognitive Assessment (MoCA) and its subtests in patients with mild cerebrovascular disease.
- To determine the association between MoCA scores and functional outcomes.
- To identify an optimal brief MoCA tool for vascular cognitive impairment.
Main Methods:
- 386 patients with minor stroke or transient ischemic attack were assessed at 3 months.
- Montreal Cognitive Assessment (MoCA) and modified Rankin Scale (mRS) were administered.
- CT scans analyzed for stroke and white matter changes; unfavorable outcome defined as mRS >1.
Main Results:
- Cognitive impairment prevalence was 55% with MoCA (cutoff 26) vs. 13% with MMSE.
- MoCA <26 was linked to unfavorable 3-month functional outcome (OR 3.00).
- A 5-subtest MoCA demonstrated 91% sensitivity and 83% specificity.
Conclusions:
- The MoCA is valuable for detecting cognitive impairment in milder cerebrovascular disease.
- MoCA scores correlate with 3-month functional outcomes.
- A brief 5-subtest MoCA may serve as an efficient screening tool for vascular cognitive impairment.
Background/Aims:
Cognitive impairment is frequent in cerebrovascular disease but often remains undetected. The Montreal Cognitive Assessment (MoCA) has been proposed in this context. Our aim was to evaluate the MoCA and its subtests in cerebrovascular disease.
Methods:
We assessed 386 consecutive patients with minor stroke (National Institutes of Health Stroke Score <4) or transient ischemic attack at 3 months. The MoCA and the modified Rankin Scale (mRS) were administered. Computed tomography (CT) scans were assessed for stroke and white matter changes. An unfavorable functional outcome was defined as mRS >1.
Results:
The prevalence of cognitive impairment (cutoff of 26) was 55% using the MoCA and 13% using the MMSE. In a multivariate analysis, MoCA <26 was associated with the outcome (OR 3.00, CI 1.78-5.03), as were remote lacunar stroke on CT and white matter changes of at least moderate severity. Five subtests (5-word recall, word list generation, trail-making, abstract reasoning and cube copy) formed an optimal short MoCA with 6/10 or less showing a sensitivity of 91% and a specificity of 83%.
Conclusion:
This study extends the utility of the MoCA to milder forms of cerebrovascular disease. The MoCA is associated with the 3-month functional outcome. Five subtests may constitute an optimal brief tool in vascular cognitive impairment.
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01:26Transient Ischemic Attack l: Introduction
01:15Ischemic Stroke l: Introduction