Domain-specific versus generalized cognitive screening in acute stroke

Area of Science:

• Neuroscience
• Clinical Psychology
• Rehabilitation Medicine

Background:

• Current cognitive assessments for stroke, like the Montreal Cognitive Assessment (MoCA), are often short-form dementia tests yielding pass/fail results.
• Stroke survivors frequently experience domain-specific cognitive deficits that may not be adequately captured by general cognitive screening tools.
• The Oxford Cognitive Screen (OCS) was developed to provide a detailed, domain-specific cognitive profile tailored for individuals post-stroke.

Purpose of the Study:

• To compare the Montreal Cognitive Assessment (MoCA) and the Oxford Cognitive Screen (OCS) in acute stroke patients.
• To evaluate and contrast the symptom specificity and clinical utility of MoCA and OCS in the acute stroke population.
• To assess the incidence and nature of cognitive impairments identified by each tool.

Main Methods:

• A cross-sectional study involving 200 consecutive stroke patients within three weeks of stroke onset.
• Patients completed both the MoCA and OCS; demographic data, lesion side, and Barthel scores were recorded.
• Inclusivity (completion rates) and cognitive impairment incidence across MoCA and OCS domains were analyzed.

Main Results:

• A high incidence of acute cognitive impairment was observed: 76% on MoCA and 86% on OCS domains.
• The OCS demonstrated higher overall sensitivity (87%) compared to MoCA (78%) and provided domain-specific insights.
• OCS identified prevalent deficits like neglect, apraxia, and reading/writing difficulties, offering differentiated profiles across hemispheres and accommodating aphasia/neglect.

Conclusions:

• The Oxford Cognitive Screen (OCS) is more sensitive than the MoCA for detecting cognitive impairments in acute stroke.
• OCS provides crucial domain-specific information on post-stroke cognitive deficits missed by the MoCA.
• The OCS is inclusive for patients with aphasia and neglect, offering a more comprehensive and less confounded cognitive profile.