Please use this identifier to cite or link to this item: https://doi.org/10.1136/jnnp-2011-302070
Title: Brief screening tests during acute admission in patients with mild stroke are predictive of vascular cognitive impairment 3-6 months after stroke
Authors: Dong, Y. 
Venketasubramanian, N. 
Chan, B.P.-L.
Sharma, V.K. 
Slavin, M.J.
Collinson, S.L. 
Sachdev, P.
Chan, Y.H.
Chen, C.L.-H. 
Issue Date: Jun-2012
Citation: Dong, Y., Venketasubramanian, N., Chan, B.P.-L., Sharma, V.K., Slavin, M.J., Collinson, S.L., Sachdev, P., Chan, Y.H., Chen, C.L.-H. (2012-06). Brief screening tests during acute admission in patients with mild stroke are predictive of vascular cognitive impairment 3-6 months after stroke. Journal of Neurology, Neurosurgery and Psychiatry 83 (6) : 580-585. ScholarBank@NUS Repository. https://doi.org/10.1136/jnnp-2011-302070
Abstract: Objectives: To determine the prognostic value of brief cognitive screening tests administered in the subacute stroke phase (initial 2 weeks) for the detection of significant cognitive impairment 3-6 months after stroke, the authors compared the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). Methods: Patients with ischaemic stroke and transient ischaemic attack were assessed with both MoCA and MMSE within 14 days after index stroke, followed by a formal neuropsychological evaluation of seven cognitive domains 3-6 months later. Cognitive outcomes were dichotomised as either no-mild (impairment in ≤2 cognitive domains) or moderateesevere (impairment in ≥3 cognitive domains) vascular cognitive impairment. Area under the receiver operating characteristic (ROC) curve analysis was used to compare discriminatory ability. Results: 300 patients were recruited, of whom 239 received formal neuropsychological assessment 3-6 months after the stroke. 60 (25%) patients had moderate-severe VCI. The overall discriminant validity for detection of moderate-severe cognitive impairment was similar for MoCA (ROC 0.85 (95% CI 0.79 to 0.90) and MMSE (ROC 0.83 (95% CI 0.77 to 0.89)), p=0.96). Both MoCA (21/22) and MMSE (25/26) had similar discriminant indices at their optimal cutoff points; sensitivity 0.88 versus 0.88; specificity 0.64 versus 0.67; 70% versus 72% correctly classified. Moreover, both tests had similar discriminant indices in detecting impaired cognitive domains. Conclusions: Brief screening tests during acute admission in patients with mild stroke are predictive of significant vascular cognitive impairment 3-6 months after stroke.
Source Title: Journal of Neurology, Neurosurgery and Psychiatry
URI: http://scholarbank.nus.edu.sg/handle/10635/49980
ISSN: 00223050
DOI: 10.1136/jnnp-2011-302070
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