title: The Montreal Cognitive Assessment is superior to National Institute of Neurological Disease and Stroke-Canadian Stroke Network 5-minute protocol in predicting vascular cognitive impairment at 1 year.
abstract: BACKGROUND
  The predictive ability of National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute protocol and Montreal Cognitive Assessment (MoCA) administered sub-acutely and at the convalescent phase after stroke for significant vascular cognitive impairment (VCI) at 1 year is unknown. We compared prognostic values of these tests.
  
  
  METHODS
  Patients with ischemic stroke and transient ischemic attack (TIA) received MoCA sub-acutely (within 2 weeks) and 3-6 months after stroke followed by a formal neuropsychological evaluation at 1 year. The total score of NINDS-CSN 5-minutes protocol was derived from MoCA. Moderate-severe VCI was defined as neuropsychological impairment in ≥ 3 domains. Area under the receiver operating characteristic curve (AUC) analyses were conducted to establish the optimal cutoff points and discriminatory properties of the MoCA and NINDS-CSN 5-minute protocol in detecting moderate-severe VCI.
  
  
  RESULTS
  Four hundre patients were recruited at baseline. Of these, 291 received a formal neuropsychological assessment 1 year after stroke. 19% patients had moderate-severe VCI. The MoCA was superior to the NINDS-CSN 5-minute protocol [sub-acute AUCs: 0.89 vs 0.80, p < 0.01; 3-6 months AUCs: 0.90 vs 0.83, p < 0.01] in predicting for moderate-severe VCI at 1 year. At respective cutoff points, MoCA had significantly higher sensitivity than the NINDS-CSN 5-minute protocol at baseline (p = 0.01) and 3-6 months (p = 0.04).
  
  
  CONCLUSIONS
  MoCA administered sub-acutely and 3-6 months after stroke is superior to the NINDS-CSN 5-minute protocol in predicting moderate-severe VCI at 1 year.
authors.affiliation: Memory Ageing and Cognition Center, Department of Pharmacology, National University Health System, Singapore, Singapore. yanhong_dong@nuhs.edu.sg.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. yanhong_dong@nuhs.edu.sg.|Division of Neurology, National University Health System, Singapore, Singapore. yanhong_dong@nuhs.edu.sg.|Centre for Healthy Brain Ageing and Dementia Collaborative Research Centre, UNSW Medicine, The University of New South Wales, Sydney, Australia. yanhong_dong@nuhs.edu.sg.|Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, BLK MD3 Level 4 #04-01, 16 Medical Drive, Singapore, 117600, Singapore. yanhong_dong@nuhs.edu.sg.
authors.forename: YanHong
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Memory Ageing and Cognition Center, Department of Pharmacology, National University Health System, Singapore, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.affiliation: Division of Neurology, National University Health System, Singapore, Singapore.
authors.forename: Bernard Poon-Lap
authors.initials: BP
authors.lastname: Chan
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.|Division of Neurology, National University Health System, Singapore, Singapore.
authors.forename: Raymond Chee Seong
authors.initials: RC
authors.lastname: Seet
authors.affiliation: Memory Ageing and Cognition Center, Department of Pharmacology, National University Health System, Singapore, Singapore.|Neuroscience Centre, Raffles Hospital, Singapore, Singapore.
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
authors.affiliation: Division of Neurology, National University Health System, Singapore, Singapore.
authors.forename: Hock Luen
authors.initials: HL
authors.lastname: Teoh
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.|Division of Neurology, National University Health System, Singapore, Singapore.
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Sharma
authors.affiliation: Memory Ageing and Cognition Center, Department of Pharmacology, National University Health System, Singapore, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Christopher Li-Hsian
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012372:ROC Curve; D020521:Stroke / Q000175:diagnosis*
keywords: Acute stroke; Cognition; Predictive value of tests; Vascular dementia