Screening for Cognitive Impairment in a Stroke Prevention Clinic Using the MoCA

Abstract

Background:Screening for cognitive impairment is recommended in patients with cerebrovascular disease. We sought to establish the incidence of cognitive impairment using the Montreal Cognitive Assessment (MoCA) in a cohort of consecutive patients attending our stroke prevention clinic (SPC), and to determine whether a subset of the MoCA could be derived for use in this busy clinical setting.Methods:The MoCA was administered to 102 patients. Incidence of cognitive impairment was compared to presenting complaint and final diagnosis. extent of cerebral white matter changes (WMC) was rated using the Age Related White Matter Changes (ARWMC) scale in 80 patients who underwent neuroimaging. A subset of the three most predictive test elements of the MoCA was derived using regression analysis.Results:63.7% of patients scored <26/30 on the MoCA, in keeping with cognitive impairment. This was unrelated to the final diagnosis or extent of WMC, although a trend for lower MoCA scores was observed in older patients. A mini-MoCA subscore combining the clock drawing test, five-word delayed recall, and abstraction was highly correlated with the final MoCA score (R=0.901). A score of <7/10 using this 10-point mini-MoCA identified cognitive impairment as defined by the MoCA with a sensitivity of 98.5%, and a specificity of 77.6%.Conclusions:Two-thirds of SPC patients demonstrated evidence for cognitive impairment, irrespective of their final diagnosis or the presence of WMC. A mini-MoCA comprised of the clock drawing test, five-word delayed recall, and abstraction represents a potential alternative to the full MoCA in this population.

Montreal Cognitive Assessment 5-Minute Protocol Is a Brief, Valid, Reliable, and Feasible Cognitive Screen for Telephone Administration

“…Third, by retaining category cueing and recognition in the delayed memory, the MoCA 5-min protocol offers important information regarding the type of memory failure that may help to differentiate subtypes of VCI. We showed that when compared to the spontaneous recall score, 4, 7 this modified scoring method correlated better with the MoCA memory domain score. Last, the MoCA 5-min protocol retains a 30-point scoring which allows a broader range of scores for more precise clinical measurement and for statistical analysis.…”

“…For example, Mai et al showed that a combination of clock drawing, delayed recall and abstraction items performed better than the combination proposed by the NINDS-CSN working group in predicting impaired MoCA performance. 7 However, their version precludes the possibility for telephone administration as drawing is required. Pendlebury et al developed two telephone versions of MoCA (T-MoCA) of different lengths, including a short version that is composed of the set of items recommended by NINDS-CSN working group.…”

“…There are at least three abbreviated versions of the MoCA that has been developed and examined in stroke patients (table 1). 4, 7 In accordance to the structure of the 5-minute protocol proposed by the NINDS-CNS Harmonization workshop, we constructed the MoCA 5-min protocol by extracting four subtests from the MoCA. The objective of this study is to examine the validity and reliability of the MoCA 5-min protocol administered over the telephone.…”

The “DOC” screen: Feasible and valid screening for depression, Obstructive Sleep Apnea (OSA) and cognitive impairment in stroke prevention clinics

“…[21] A previous study retrospectively extracted 10-points of the MoCA (5-word recall (5), clock drawing (3), and abstraction (2) and demonstrated strong predictive value for detecting cognitive impairment. [22] We selected this 10-point version of the MoCA (DOC-Cog) to prospectively validate in the stroke clinic population. We integrated the PHQ-2 (DOC-Mood) and STOP questionnaire (DOC-Apnea) into the delay between registration and recall of the 5 word recall task.…”

Cognitive impairment and risk of future stroke: a systematic review and meta-analysis

“…55 Screening for cognitive impairment has been recommended in patients with stroke, given results from a recent Canadian study showing that two-thirds of stroke patients have evidence for cognitive impairment. 56 Our findings suggest that identifying people with cognitive impairment may provide an even bigger opportunity to reduce the future burden of stroke through the timely implementation of evidence-based prevention strategies.…”