Montreal Cognitive Assessment performance in older adults with post-stroke delirium: global and subscale analysis

We investigated whether global cognitive performance and scores on individual MoCA subscales differ between patients with and without post-stroke delirium.

Although delirium and cognitive decline are interrelated, associations between post-stroke delirium and specific cognitive deficits remain unclear.

We analyzed data from the Prospective Observational Polish Study on post-stroke delirium (PROPOLIS) and selected patients without prior cognitive decline who underwent the Montreal Cognitive Assessment (MoCA) on days 1 and 8 after ischemic stroke. We included patients with delirium on day 1 who were delirium-free by day 8 and patients without delirium matched for age, stroke severity, lesion hemisphere, and pre-stroke cognitive performance. We used MoCA-Blind for the primary analysis because some patients were unable to perform visual MoCA items.

Of the 162 eligible patients, 18 patients with delirium were matched to 46 patients without delirium. On day 1, patients with delirium had significantly lower total MoCA-Blind scores (median: 10.5 vs. 15, p < 0.001) and on the following MoCA subscales: attention, language, delayed recall, and orientation. On day 8, patients with delirium had lower scores of total MoCA- -Blind (median: 12 vs. 17, p < 0.001) and MoCA subscales: attention, language, abstraction, and orientation. Between days 1 and 8, both groups improved on MoCA-Blind, but patients with delirium showed greater improvement in attention (median change: 1 vs. 0, p = 0.044) and the orientation subscale (median change: 0.5 vs. 0, p = 0.011) than patients without delirium.

Delirium following ischemic stroke is associated with worse global cognitive performance rather than deficits in specific MoCA subscales. Resolution of delirium is associated with improvements in attention and orientation, but not in other subscales.