Diagnostic test accuracy of the Montreal Cognitive Assessment in the detection of post-stroke cognitive impairment under different stages and cutoffs: a systematic review and meta-analysis

Shi, Dan; Chen, Xiao; Lv, Zheng

doi:10.1007/s10072-018-3254-0

Cited by 71 publications

(52 citation statements)

References 41 publications

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“…Although its specificity in separating VaD from controls was high (93%‐97%), the MoCA's ability to correctly differentiate VMCI from controls was lower, varying from 75.6% to 79% . This is similar to other studies including a recent systematic review and meta‐analysis, which have shown that while sensitive, the specificity of the MoCA in identifying MCI syndromes is lower, particularly at its established cut‐off of less than 26 out of 30, including for post‐stroke cognitive impairment …”

Section: Discussionsupporting

confidence: 79%

Cognitive screening instruments to identify vascular cognitive impairment: A systematic review

Ghafar

Miptah

Ó’Caoimh

2019

Int J Geriat Psychiatry

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Introduction Vascular cognitive impairment (VCI) is common and important to detect as controlling risk factors, particularly hypertension, may slow onset and progression. There is no consensus as to which cognitive screening instrument (CSI) is most suitable for VCI. We systematically reviewed the psychometric properties of brief CSIs for vascular mild cognitive impairment (VMCI) and vascular dementia (VaD). Methods Literature searches were performed using scholarly databases from inception until 31 May 2018. Studies were eligible if participants were aged 18 or older, interviewed face‐to‐face, and standard diagnostic criteria for VCI were applied, excluding those specifically identifying post‐stroke dementia. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results Fifteen studies were identified including eight types of CSIs (27 subtests/variants) and 4575 participants (1015 with VCI), mean age range: 51.6 to 75.5 years. Most studies compared more than one instrument. Five papers examined clock‐drawing; four, the Montreal Cognitive Assessment (MoCA) and Mini‐Mental State Examination (MMSE); and three used the Brief Memory and Executive Test (BMET). The MoCA (AUC > 0.90) and MMSE (AUC: 0.86‐0.99) had excellent accuracy in differentiating VaD from controls; the MoCA had good internal consistency (Cronbach's α: .83‐.88). The MoCA (AUC: 0.87‐0.93) and BMET (AUC: 0.94) had the greatest accuracy in separating VMCI from controls. Most studies had low to moderate risk of bias in all domains of the QUIPS. Data were heterogeneous, precluding a meta‐analysis. Conclusions Although few studies were available and further research is required, data suggests that the MoCA is accurate and reliable for differentiating VaD and VMCI from controls.

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Section: Discussionsupporting

confidence: 79%

Cognitive screening instruments to identify vascular cognitive impairment: A systematic review

Ghafar

Miptah

Ó’Caoimh

2019

Int J Geriat Psychiatry

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“…An optimal cut-off point for normal cognitive functioning has been previously discussed 19 . To address this problem, we studied the relationship between a dichotomized Cog-4 and three different cut-off points for the MoCA.…”

Section: Discussionmentioning

confidence: 99%

“…The threshold for impaired cognition was set at ≥1 p on the Cog-4 8 . Three MoCA thresholds at ≤19 p, ≤23 p, and ≤25 p were chosen for impaired cognitive functioning according to previous literature 19 . Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated, and a 95% www.nature.com/scientificreports www.nature.com/scientificreports/ confidence interval (95% CI) was presented for each analysis.…”

Section: Assessment Instrumentsmentioning

confidence: 99%

NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study

Abzhandadze

Reinholdsson

Sunnerhagen

2020

Sci Rep

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the aim of this study was to investigate whether the cognitive subscale of the national institute of Health Stroke Scale (NIHSS), the Cog-4, can detect cognitive deficits in acute stroke. This was a cross-sectional, retrospective study. The study sample consisted of people with stroke enrolled in an acute stroke unit. The index test Cog-4 was calculated based on admission NIHSS score. The reference standard instrument, the Montreal Cognitive Assessment (MoCA), was performed within 36-48 h of admission. Non-parametric statistics were used for data analyses. The study included 531 participants with a mean age of 69 years. The Cog-4 failed to identify cognitive deficits in 65%, 58%, and 53% of patients when the MocA thresholds for impaired cognition were set at ≤25 p, ≤23 p, and ≤19 p, respectively, were chosen for impaired cognition. The agreement between the Cog-4 and the MoCA was poor; cohen's kappa was from −0.210 to −0.109, depending on the MoCA cutoffs. The sensitivity of the Cog-4 was 35%, 42% and 48% for the MoCA thresholds for impaired cognition ≤25, ≤23 and ≤19 points, respectively. The Cog-4 has a limited ability to identify cognitive deficits in acute stroke. More structured and comprehensive tests should be employed as diagnostic tools. Cognitive difficulties are common manifestations during the acute phase of stroke and can persist after a seemingly successful neurological recovery affecting the daily lives of people who had a stroke 1,2. Cognitive deficits are linked with poor outcomes 3,4 ; thus, early identification of stroke-related cognitive impairments is important. Pinpointing the superior assessment tool for evaluating cognitive function after stroke is difficult 5. The National Institute of Health Stroke Scale (NIHSS) is a routinely used instrument for the assessment of stroke-related neurological deficits, but limited sensitivity for detecting cognitive deficits has been shown 6,7. However, Cumming et al. 8 suggested that the NIHSS subscale, the Cog-4, could be used to make a statement about cognition 8. The Cog-4 is estimated based on four items of the NIHSS-orientation, executive ability, language skills and extinction and inattention. The score range is 0-9 points, where 0 points indicates no cognitive deficits. Conflicting results have been reported regarding the capacity of Cog-4 to identify cognitive deficits after stroke 8-11. Some studies have reported that the Cog-4 cannot be considered a useful cognitive scale 9,10. Another study indicated that the Cog-4 is almost as good as other commonly used screening tools for cognition in patients with severe cognitive deficits 8. In these studies, the Cog-4 was compared with the Mini-Mental State Examination (MMSE) 8 , the Montreal Cognitive Assessment (MoCA) 10 , and follow-up assessment with the Cog-4 11. Assessments were performed within 1-4 days 10 , 90 days 9 , and 18 months 8 after stroke. It still remains unclear whether the Cog-4 can identify cognitive difficulties after stroke, especially very early after the onset of stroke. Cognitiv...

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“…There have been studies revealing that T2DM is one of the common risk factors in causing stoke and CI. Thus patients with T2DM are more likely to have cognitive dysfunction after a stroke (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Effect of DPP-4 inhibitor on elderly patients with T2DM combined with MCI

et al. 2019

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The aim of this study was to investigate the effect of dipeptidyl peptidase-4 (DPP-4) inhibitor on blood sugar level and cognitive ability in elderly patients with type 2 diabetes mellitus (T2DM) combined with post-stroke mild cognitive impairment (MCI). Thirty patients received DPP-4 inhibitor (study group), while another thirty received sulfonylurea (control group).Six months after treatment, markers regarding blood sugar were improved in both groups (all P<0.05) without intergroup differences (all P>0.05); scores regarding cognitive ability improved in the study group (both P<0.05) and were higher versus the control group (both P<0.01); the study group had higher Aβ1-42/Aβ1-40 value versus the pretreatment value (P<0.001), which differed from the control group (P<0.05); tumor necrosis factor-α and interleukin-6 concentrations decreased in both groups, while the study group had greater reductions; C-reactive protein value decreased after treatment in the study group (all P<0.05).Using DPP-4 inhibitor in elderly patients with T2DM combined with post-stroke MCI can lower blood sugar and improve cognitive ability. The mechanism may be associated with the improvement of Aβ gathering and reduction in inflammatory response.

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Diagnostic test accuracy of the Montreal Cognitive Assessment in the detection of post-stroke cognitive impairment under different stages and cutoffs: a systematic review and meta-analysis

Cited by 71 publications

References 41 publications

Cognitive screening instruments to identify vascular cognitive impairment: A systematic review

Cognitive screening instruments to identify vascular cognitive impairment: A systematic review

NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study

Effect of DPP-4 inhibitor on elderly patients with T2DM combined with MCI

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