title: Brief screening tests during acute admission in patients with mild stroke are predictive of vascular cognitive impairment 3-6 months after stroke.
abstract: OBJECTIVE
  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 moderate-severe (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.
authors.affiliation: Department of Pharmacology, National University Health System, Singapore.
authors.forename: YanHong
authors.initials: Y
authors.lastname: Dong
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
authors.forename: Bernard Poon-Lap
authors.initials: BP
authors.lastname: Chan
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Sharma
authors.forename: Melissa Jane
authors.initials: MJ
authors.lastname: Slavin
authors.forename: Simon Lowes
authors.initials: SL
authors.lastname: Collinson
authors.forename: Perminder
authors.initials: P
authors.lastname: Sachdev
authors.forename: Yiong Huak
authors.initials: YH
authors.lastname: Chan
authors.forename: Christopher Li-Hsian
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010343:Patient Admission; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012846:Singapore; D020521:Stroke / Q000150:complications / Q000175:diagnosis*