title: The test accuracy of the Montreal Cognitive Assessment (MoCA) by stroke lateralisation.
abstract: BACKGROUND
  The Montreal Cognitive Assessment (MoCA) is an increasingly popular screening tool for detecting cognitive impairment post-stroke. However its' test accuracy by stroke lateralisation is as yet unknown.
  
  
  OBJECTIVE
  Our aim was to investigate whether the test accuracy of the MoCA differs by stroke lateralisation across different cognitive domains.
  
  
  METHODS
  We retrospectively examined the cognitive profiles of 228 subacute stroke patients (86 Left, 142 Right), comparing MoCA-total and domain-specific scores with performance on detailed neuropsychological assessment.
  
  
  RESULTS
  The prevalence of cognitive impairment detected on neuropsychological assessment was high and relatively comparable between the right and left hemisphere stroke groups (91% and 93% respectively). Notably however, 29% of the right stroke group and 6% of the left stroke group achieved a "cognitively-intact" MoCA score (≥25). A high proportion of right stroke patients who had an overall MoCA-intact score were found to be impaired in intellectual functioning, processing speed, executive functions and non-verbal memory on neuropsychological assessment. Furthermore, a high proportion of patients who scored full-marks within a MoCA-specified domain, irrespective of their overall score, were found to have impairment on corresponding neuropsychological assessment for both stroke groups.
  
  
  CONCLUSIONS
  Particular care needs to be taken in interpreting MoCA-intact performance for right hemisphere patients due to its poor sensitivity to right hemisphere deficits. Scoring maximum points within a MoCA-specified domain also does not necessarily indicate intact cognitive functioning in that domain. Clinicians should consider supplementing their MoCA assessment with additional tools to increase the test accuracy of detecting relevant cognitive impairments post-stroke.
authors.affiliation: Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Stroke Research Group, UCL Institute of Neurology, London, UK. Electronic address: edgar.chan@uclh.nhs.uk.
authors.forename: Edgar
authors.initials: E
authors.lastname: Chan
authors.affiliation: Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
authors.forename: Samantha
authors.initials: S
authors.lastname: Altendorff
authors.affiliation: Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
authors.forename: Colm
authors.initials: C
authors.lastname: Healy
authors.affiliation: Stroke Research Group, UCL Institute of Neurology, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Werring
authors.affiliation: Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cipolotti
mesh_terms: D000368:Aged; D003071:Cognition; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D056344:Executive Function; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*
keywords: Cognition; Executive functions; Lateralisation; Montreal cognitive assessment; Neuropsychology; Stroke