title: Improving screening for vascular cognitive impairment at three to six months after mild ischemic stroke and transient ischemic attack.
abstract: BACKGROUND
  The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were compared with and without the addition of a brief processing speed test, the symbol digit modalities test (SDMT), for vascular cognitive impairment (VCI) screening at three to six months after stroke.
  
  
  METHODS
  Patients with ischemic stroke and transient ischemic attack were assessed with MoCA and MMSE, as well as a formal neuropsychological battery three to six months after stroke. VCI was defined by impairment in any cognitive domain on neuropsychological testing. The area under the receiver operating characteristic curve (AUC) was used to compare test discriminatory ability.
  
  
  RESULTS
  One hundred and eighty-nine patients out of 327 (58%) had VCI, of whom 180 (95%) had vascular mild cognitive impairment (VaMCI), and nine (5%) had dementia. The overall AUCs of the MoCA and MMSE scores and performance at their respective cut-off points were equivalent in detecting VCI (AUCs: 0.87 (95% CI 0.83-0.91) vs. 0.84 (95% CI 0.80-0.88), p = 0.13; cut-offs: MoCA (≤23) vs. MMSE (≤26), sensitivity: 0.78 vs. 0.71; specificity: 0.80 vs. 0.82; positive predictive value: 0.84 vs. 0.84; negative predictive value: 0.72 vs. 0.67; and correctly classified 78.6% vs. 75.5%; p = 0.42). The AUCs of MMSE and MoCA were improved significantly by the SDMT (AUCs: MMSE+SDMT 0.90 (95% CI 0.87-0.93), p <0.001; MoCA+SDMT 0.91 (95% CI 0.88-0.94), p < 0.02).
  
  
  CONCLUSIONS
  The MoCA and MMSE are equivalent and moderately sensitive, and can be supplemented with the SDMT to improve their accuracy in VCI screening.
authors.affiliation: Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore.
authors.forename: YanHong
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia.
authors.forename: Melissa Jane
authors.initials: MJ
authors.lastname: Slavin
authors.affiliation: Department of Medicine, National University Health System, Singapore.
authors.forename: Bernard Poon-Lap
authors.initials: BP
authors.lastname: Chan
authors.affiliation: Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore.
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
authors.affiliation: Department of Medicine, National University Health System, Singapore.
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Sharma
authors.affiliation: Department of Psychology, National University of Singapore, Singapore.
authors.forename: Simon Lowes
authors.initials: SL
authors.lastname: Collinson
authors.affiliation: Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia.
authors.forename: Perminder Singh
authors.initials: PS
authors.lastname: Sachdev
authors.affiliation: Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore.
authors.forename: Christopher Li-Hsian
authors.initials: CL
authors.lastname: Chen
mesh_terms: D019540:Area Under Curve; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D015140:Dementia, Vascular / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D007361:Intelligence Tests / Q000592:standards; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards; D011237:Predictive Value of Tests; D058996:Quality Improvement; D012372:ROC Curve; D012720:Severity of Illness Index; D012846:Singapore; D020521:Stroke / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D013997:Time Factors