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Abstract
Objective To examine whether the Montreal Cognitive Assessment (MoCA) administered within 7 days after stroke predicts long-term cognitive impairment, functional impairment, and mortality.
Methods MoCA was administered to 274 patients from 2 prospective hospital-based cohort studies in Germany (n = 125) and France (n = 149). Cognitive and functional outcomes were assessed at 6, 12, and 36 months after stroke by comprehensive neuropsychological testing, the Clinical Dementia Rating (CDR) scale, the modified Rankin Scale (mRS), and Instrumental Activities of Daily Living (IADL) and analyzed with generalized estimating equations. All-cause mortality was investigated by Cox proportional hazard models. Analyses were adjusted for demographic variables, education, vascular risk factors, premorbid cognitive status, and NIH Stroke Scale scores. The additive predictive value of MoCA was examined with receiver operating characteristic curves.
Results In pooled analyses, a baseline MoCA score <26 was associated with cognitive impairment, defined by neuropsychological testing (odds ratio [OR] 5.30, 95% confidence interval [CI] 2.75–10.22) and by CDR score ≥0.5 (OR 2.53, 95% CI 1.53–4.18); functional impairment, defined by mRS score >2 (OR 5.03, 95% CI 2.20–11.51) and by IADL score <8 (OR 2.48, 95% CI 1.40–4.38); and mortality (hazard ratio 7.24, 95% CI 1.99–26.35) across the 3-year follow-up. Patients with MoCA score <26 performed worse across all prespecified cognitive domains (executive function/attention, memory, language, visuospatial ability). MoCA increased the area under the curve for predicting cognitive impairment (neuropsychological testing 0.81 vs 0.72, p = 0.01) and functional impairment (mRS score >2, 0.88 vs 0.84, p = 0.047).
Conclusion Early cognitive testing by MoCA predicts long-term cognitive outcome, functional outcome, and mortality after stroke. Our results support routine use of the MoCA in stroke patients.
Glossary
- AUC=
- area under the ROC curve;
- CDR=
- Clinical Dementia Rating;
- CI=
- confidence interval;
- DEDEMAS=
- Determinants of Dementia After Stroke;
- IADL=
- Instrumental Activities of Daily Living;
- IQCODE=
- Informant Questionnaire on Cognitive Decline in the Elderly;
- MoCA=
- Montreal Cognitive Assessment;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- ROC=
- receiver operating characteristic;
- STROKDEM=
- Study of Factors Influencing Post-Stroke Dementia;
- TOAST=
- Trial of Org 10172 in Acute Stroke Treatment
Footnotes
↵* These authors contributed equally to this work.
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 903
- Received March 14, 2018.
- Accepted in final form August 1, 2018.
- © 2018 American Academy of Neurology
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