title: Cognitive screening improves the predictive value of stroke severity scores for functional outcome 3-6 months after mild stroke and transient ischaemic attack: an observational study.
abstract: OBJECTIVE
  To investigate the prognostic value of the neurocognitive status measured by screening instruments, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), individually and in combination with the stroke severity scale, the National Institute of Health Stroke Scale (NIHSS), obtained at the subacute stroke phase or the baseline (≤2 weeks), for functional outcome 3-6 months later.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Tertiary stroke neurology service.
  
  
  METHODS
  400 patients with a recent ischaemic stroke or transient ischaemic attack (TIA) received NIHSS, MoCA and MMSE at baseline and were followed up 3-6 months later.
  
  
  METHODS
  At 3-6 months following the index event, functional outcome was measured by the modified Rankin Scale (mRS) scores.
  
  
  RESULTS
  Most patients (79.8%) had a mild ischaemic stroke and less disability (median NIHSS=2, median mRS=2 and median premorbid mRS=0), while a minority of patients had TIA (20.3%). Baseline NIHSS, MMSE and MoCA scores individually predicted mRS scores at 3-6 months, with NIHSS being the strongest predictor (NIHSS: R(2) change=0.043, p<0.001). Moreover, baseline MMSE scores had a small but statistically significant incremental predictive value to the baseline NIHSS for mRS scores at 3-6 months, while baseline MoCA scores did not (MMSE: R(2) changes=0.006, p=0.03; MoCA: R(2) changes=0.004, p=0.083). However, in patients with more severe stroke at baseline (defined as NIHSS>2), baseline MoCA and MMSE had a significant and moderately large incremental predictive value to the baseline NIHSS for mRS scores at 3-6 months (MMSE: R(2) changes=0.021, p=0.010; MoCA: R(2) changes=0.017, p=0.021).
  
  
  CONCLUSIONS
  Cognitive screening at the subacute stroke phase can predict functional outcome independently and improve the predictive value of stroke severity scores for functional outcome 3-6 months later, particularly in patients with more severe stroke.
authors.affiliation: Department of Pharmacology, Memory Aging and Cognition Centre, National University Health System, Singapore.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Dong
authors.forename: Melissa Jane
authors.initials: MJ
authors.lastname: Slavin
authors.forename: Bernard Poon-Lap
authors.initials: BP
authors.lastname: Chan
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Sharma
authors.forename: John D
authors.initials: JD
authors.lastname: Crawford
authors.forename: Simon Lowes
authors.initials: SL
authors.lastname: Collinson
authors.forename: Perminder
authors.initials: P
authors.lastname: Sachdev
authors.forename: Christopher Li-Hsian
authors.initials: CL
authors.lastname: Chen
keywords: GERIATRIC MEDICINE; REHABILITATION MEDICINE