Word recall was also performed poorly, raising the possibility that memory is often a problem poststroke, but the deficit is only detected when the recall task is sufficiently difficult. Performance was poor on items that have large attentional and executive demands, including trail-making, cube copy, and letter fluency. Resolving this question requires comparison of the MoCA against extended neuropsychological testing or better-matched control data. 1 This high prevalence may reflect the sensitivity of the MoCA, but it is also possible that the recommended “normal” cutoff is too high for the current population. 7, 8 Severe stroke or acute aphasia was often no barrier to the MoCA completion at 3 months poststroke.Ī majority of patients with stroke (65%) were classified as cognitively impaired, which matches previous findings, whether the MoCA was used 7 or not. Our findings extend earlier studies in milder populations of mixed stroke and transient ischemic attack. Nevertheless, the important issue of missing data from cognitive measures remains and must be addressed in statistical analysis. This completion rate, similar to that found in a population-based study, 7 is impressive given that trial inclusion criteria were broad: 55% of patients had moderate or severe stroke (National Institutes of Health Stroke Scale >7) and those with hemorrhagic stroke or previous stroke were not excluded. Therefore, 35 of 274 (13%) patients had missing data due to patient factors (including aphasia, refusal, insufficient English). Only 54 of 274 (20%) patients surviving to 3 months had incomplete MoCA data, and in 19 cases, this was due to telephone follow-up. This study demonstrates that administering the MoCA at 3 months poststroke is feasible. 9 We hypothesized that administering the MoCA would be feasible and that a majority of patients with stroke would be classified as cognitively impaired (<26 of 30). 7, 8 In 2008, the MoCA was included as a 3-month outcome in A Very Early Rehabilitation Trial (AVERT), an ongoing multicenter trial of earlier and more frequent mobilization after stroke. 6 Superior sensitivity has also been demonstrated in stroke populations. 5 Early validation studies indicated that the MoCA had >80% sensitivity to detect mild cognitive impairment compared with the Mini-Mental State Examination's sensitivity of <20%. 4 Recently, the Montreal Cognitive Assessment (MoCA) has been proposed as a screening tool that promises greater sensitivity to deficits arising from stroke and vascular cognitive impairment. 3 The profile of poststroke vascular cognitive impairment differs from the more predictable memory-focused decline of Alzheimer disease, and the Mini-Mental State Examination can lack validity in patients with stroke. 2 Many existing cognitive screening tools were developed for dementia and are weighted toward memory and orientation (eg, the Mini-Mental State Examination). Of 190 acute stroke treatment trials, only 3 included specific measures of cognitive outcome. Customer Service and Ordering InformationĬognitive function is often compromised after stroke, 1 yet it is rarely assessed in research trials.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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