Neuropsychological screening in the acute phase of cerebrovascular diseases

Abstract

Introduction Cognitive impairment is a common and disabling consequence of stroke. Its prevalence, the best way to screen for it in the acute setting, and its relation with premorbid status have not been thoroughly clarified. Materials and methods Ischemic and hemorrhagic stroke patients admitted to our stroke unit underwent a baseline assessment that included a clinical and neuroimaging assessment, two cognitive tests (clock‐drawing test, CDT; Montreal Cognitive Assessment‐Basic, MoCA‐B) and measures of premorbid function (including the Clinical Dementia Rating Scale). A follow‐up examination was repeated 3‐4 months after the acute event. Results Two hundred and twenty‐three patients (52.5% women, mean age ± SD 75.8 years ± 12.3) were evaluated. Prestroke cognitive impairment was present in 91 patients (40.8%). At follow‐up, the prevalence of cognitive impairment was 49%, while its incidence among patients who did not have any prestroke cognitive impairment was 38.8%. Of the originally admitted 223 patients (71 were lost to follow‐up), only 60 (26.9%) were still cognitively intact at follow‐up. On regression analysis, age and baseline CDT were associated with worsening of cognitive status at follow‐up. In patients without cognitive impairment at baseline, a cutoff of 23 for MoCA‐B and of 8.7 for CDT scores predicted the diagnosis of post‐stroke cognitive impairment with sufficient accuracy. Discussion and conclusion Prestroke and post‐stroke cognitive impairment affect a large proportion of patients with stroke. Our findings suggest that a neuropsychological screening during the acute phase might be predictive of the development of post‐stroke cognitive impairment.

Accuracy of the Clock Drawing Test in Screening for Early Post-Stroke Neurocognitive Disorder: The Nor-COAST Study

“…To our knowledge, only one study to date has examined the CDT's accuracy in diagnosing NCD among stroke survivors. In that research, Cova et al observed a sensitivity of 80%, speci city of 76% and an AUC of 0.86 (20). Several methodological differences between our studies might explain the divergence in our results.…”

“…Compared with Munthe-Kaas et al's research, also within the Nor-COAST study, addressing the accuracy of MoCA for NCD in stroke patients, we found the CDT to be inferior to the MoCA in identifying post-stroke NCD (12). In that research, the MoCA had an AUC approaching 0.80 with 71% sensitivity and 73% speci city for post-stroke NCD (12), and other studies have revealed similar results (13,20,34,35). The MMSE has also been validated for stroke survivors but found to be less sensitive than the MoCA, especially for identifying mild NCD (11,13,34,35).…”

“…Its validity for non-stroke NCD is well documented (19). To our knowledge, only one previous study has examined the validity of the CDT for post-stroke NCD, presenting adequate levels of sensitivity and speci city (20). The study's sample of 98 participants was small, however, and a replication of this study with a larger sample size is therefore requested.…”

Comparison of Oxford Cognitive Screen and Montreal Cognitive Assessment feasibility in the stroke unit setting. A pilot study

“…The Montreal Cognitive Assessment (MoCA) test was originally developed to identify mild cognitive impairment in aging [7] . MoCA has been widely used also in stroke patients, but its sensitivity and predictive validity in acute stroke settings are reported only in few studies [8] , [9] , [10] . A more recent instrument, the Oxford Cognitive Screen (OCS) [11] , was specifically developed to measure domain-specific cognitive deficits in patients after acute stroke.…”

Associations between cognitive impairment and cerebrovascular reserve in different lobes during the acute stroke of anterior circulations

“…Cognitive function in the acute stroke setting was previously reported to be a predictive factor for PSCI development 4,12 . Lee et al (2020) reported that 63.8% of patients presented cognitive impairments from acute ischemic strokes (28.8% with mild cognitive impairment and 35.0% with severe cognitive impairment) 13 .…”