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Updated: Nov 2, 2025

Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients

Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients

Published on: December 16, 2022

Evaluating High-Functioning Young Stroke Survivors with Cognitive Complaints.

Alexander D Rebchuk¹, Leah E Kuzmuk², Halina M Deptuck³

¹Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques

|June 17, 2021

Summary

The National Institutes of Health (NIH) Toolbox Cognition Battery (NIHTB-CB) effectively identified cognitive deficits in high-functioning stroke survivors, unlike the Montreal Cognitive Assessment (MoCA). This suggests NIHTB-CB is a more sensitive tool for stroke cognition research.

Keywords:

Cognition Cognitive impairment MoCA Rehabilitation Stroke Young adults

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Area of Science:

Neuroscience
Clinical Neurology
Cognitive Psychology

Background:

The Montreal Cognitive Assessment (MoCA) is frequently used in stroke trials but may lack sensitivity for high-functioning survivors.
The National Institutes of Health (NIH) Toolbox Cognition Battery (NIHTB-CB) offers a comprehensive, tablet-based cognitive assessment.
Assessing cognitive function in young stroke survivors with subjective complaints requires sensitive outcome measures.

Purpose of the Study:

To compare the sensitivity of MoCA and NIHTB-CB in detecting cognitive impairment in young stroke survivors with excellent functional outcomes.
To evaluate the utility of NIHTB-CB as a cognitive outcome measure in clinical trials involving high-functioning stroke survivors.

Main Methods:

A cohort of 53 young stroke survivors (18-55 years) with modified Rankin Scale scores of 0-1 and subjective cognitive complaints were compared to 53 age-matched healthy controls.
Participants completed both the MoCA and the NIHTB-CB.
A sensitivity analysis was conducted on participants with normal MoCA scores (≥26).

Main Results:

No significant difference in MoCA scores was observed between stroke survivors and controls.
Stroke survivors exhibited significantly lower mean T scores on all NIHTB-CB components (fluid, crystallized, and total cognition) compared to controls (p < 0.001).
Even among participants with normal MoCA scores, NIHTB-CB revealed significant cognitive deficits in stroke survivors.

Conclusions:

The NIHTB-CB demonstrated superior sensitivity in detecting cognitive differences between young stroke survivors and healthy controls, particularly in those with excellent functional outcomes and subjective cognitive complaints.
The MoCA was insufficient for identifying these cognitive deficits.
The NIHTB-CB is a promising outcome measure for cognitive assessment in clinical trials focused on higher-functioning young stroke survivors.