How predictive is the MMSE for cognitive performance after stroke?

Abstract

Cognitive deficits are commonly observed in stroke patients. Neuropsychological testing is time-consuming and not easy to administer after hospital discharge. Standardised screening measures are desirable. The Mini-Mental State Examination (MMSE) is the test most widely applied to screen for cognitive deficits. Despite its broad use, its predictive characteristics after stroke have not been exhaustively investigated. The aim of this study was to determine whether the MMSE is able to adequately screen for cognitive impairment and dementia after stroke and whether or not the MMSE can predict further deterioration or recovery in cognitive function over time. To this end, we studied 194 first-ever stroke patients without pre-stroke cognitive deterioration who underwent MMSEs and neuropsychological test batteries at 1, 6, 12, and 24 months after stroke. The MMSE score 1 month after stroke predicted cognitive functioning at later follow-up visits. It could not predict deterioration or improvement in cognitive functioning over time. The cut-off score in the screening for 1 cognitive disturbed domain was 27/28 with a sensitivity of 0.72. The cut-off score in the screening for at least 4 impaired domains and dementia were 26/27 and 23/24 with a sensitivity of 0.82 and 0.96, respectively. The results indicated that the MMSE has modest qualities in screening for mild cognitive disturbances and is adequate in screening for moderate cognitive deficits or dementia in stroke patients 1 month after stroke. Poor performance on the MMSE is predictive for cognitive impairment in the long term. However, it cannot be used to predict further cognitive deterioration or improvement over time.

Prevalence of Poststroke Cognitive Impairment

“…It has been shown that MMSE or Abbreviated Mental Test are insensitive to mild cognitive impairment and executive function. 19,24,25 Although these are limitations in detecting mild cases, this study has shown high prevalence of cognitive impairments. Similar large long-term studies of poststroke cognitive function using sensitive tools to detect all cases, including mild cognitive impairments, will be of benefit to reconfirm the burden of this condition.…”

“…[19][20][21] It not only provides population estimates, to our knowledge for the first time, on the longer term cognitive outcomes in a diverse innercity population, but it also highlights the long-term impacts of stroke in subgroups of the population and illustrates the risk of cognitive impairment long term. It is rare that population-based studies estimate this range of outcomes in such a prospective …”

Cognitive Impairment Evaluated With Vascular Cognitive Impairment Harmonization Standards in a Multicenter Prospective Stroke Cohort in Korea

“…The subjects had a score below the 2 nd percentile of the K-MMSE score of the norm group were defined as VaD, and between the 2 nd and 10 th percentile were VCIND. 7,[14][15][16][17] Statistical Analysis…”

Are Cognitive Screening Tools Sensitive and Specific Enough for Use After Stroke?

“…Unfortunately, 5 studies did not sufficiently report this information, 16,18,20,23,24 and 3 reported the mean time interval between assessments as >10 days. 11,15,25 Only 6 studies stratified sensitivity or specificity results according to demographic or stroke variables. 20,22,23,[25][26][27] …”

“…11,15,25 Only 6 studies stratified sensitivity or specificity results according to demographic or stroke variables. 20,22,23,[25][26][27] …”