title: Underestimation of cognitive impairments by the Montreal Cognitive Assessment (MoCA) in an acute stroke unit population.
abstract: OBJECTIVE
  The Montreal Cognitive Assessment (MoCA) is an increasingly popular clinical screening tool for detecting cognitive impairment in stroke, but few studies have directly compared performance on the MoCA with neuropsychological assessment. Our retrospective study examined the extent to which intact performance on the MoCA reflects intact cognition as determined by neuropsychological assessment.
  
  
  METHODS
  In this retrospective study, cognitive profiles for 136 acute stroke patients admitted to the Acute Stroke Unit who had available MoCA and neuropsychological assessment data were examined.
  
  
  RESULTS
  22% of our patients were deemed cognitively intact on the MoCA. Of these, 78% were found to be impaired (≤ 5%ile) on neuropsychological assessment in one or more cognitive domains. The most common impairments were in general intelligence, information processing speed and visual memory; three areas not assessed by the MoCA. In addition, a high proportion (up to 59%) of patients who scored the maximum points in one of the MoCA-specified domains were impaired on comparable neuropsychological assessment.
  
  
  CONCLUSIONS
  Our findings suggest that although the MoCA may be a useful screening tool post-stroke in detecting gross impairments, neuropsychological assessment is still necessary for a comprehensive and reliable detection of domain-specific cognitive deficits, which can more reliably inform us for realistic goal setting and vocational advice vital for effective rehabilitation.
authors.affiliation: National Hospital for Neurology and Neurosurgery, London, UK. Electronic address: edgar.chan@uclh.nhs.uk.
authors.forename: Edgar
authors.initials: E
authors.lastname: Chan
authors.affiliation: National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Sabah
authors.initials: S
authors.lastname: Khan
authors.affiliation: National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Rupert
authors.initials: R
authors.lastname: Oliver
authors.affiliation: University College London Hospital, London, UK.
authors.forename: Sumanjit K
authors.initials: SK
authors.lastname: Gill
authors.affiliation: UCL Institute of Neurology, Stroke Research Group, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Werring
authors.affiliation: National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cipolotti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D020521:Stroke / Q000150:complications* / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
keywords: Cognition; Cognitive assessment; MoCA; Neuropsychology; Stroke; Vascular disease