Skip to main content Accessibility help
×
Home
Hostname: page-component-5959bf8d4d-89n48 Total loading time: 0.257 Render date: 2022-12-09T14:12:48.893Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Improving screening for vascular cognitive impairment at three to six months after mild ischemic stroke and transient ischemic attack

Published online by Cambridge University Press:  15 January 2014

YanHong Dong
Affiliation:
Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia
Melissa Jane Slavin
Affiliation:
Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia
Bernard Poon-Lap Chan
Affiliation:
Department of Medicine, National University Health System, Singapore
Narayanaswamy Venketasubramanian
Affiliation:
Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore Department of Medicine, National University Health System, Singapore Neuroscience Clinic, Raffles Hospital, Singapore
Vijay Kumar Sharma
Affiliation:
Department of Medicine, National University Health System, Singapore
Simon Lowes Collinson
Affiliation:
Department of Psychology, National University of Singapore, Singapore
Perminder Singh Sachdev
Affiliation:
Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia
Christopher Li-Hsian Chen*
Affiliation:
Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore
*
Correspondence should be addressed to: Dr. Christopher Li-Hsian Chen, MD, Clinical Research Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, MD11, Level 5, #05-9, 10 Medical Drive, Singapore117597. Phone: +65-65165885; Fax: +65-68724101. Email: phccclh@nus.edu.sg.

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.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google ScholarPubMed
Crum, R. M., Anthony, J. C., Bassett, S. S. and Folstein, M. F. (1993). Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA, 269, 23862391.CrossRefGoogle ScholarPubMed
Diller, L. et al. (1974). Studies in Cognition and Rehabilitation in Hemiplegia. New York: University Medical Center, Rehabilitation Monograph, no. 50.Google Scholar
Dong, Y. et al. (2010). The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. Journal of the Neurological Sciences, 299, 1518.CrossRefGoogle ScholarPubMed
Dong, Y. et al. (2012). Brief screening tests during acute admission in patients with mild stroke are predictive of vascular cognitive impairment 3–6 months after stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 83, 580585.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Godefroy, O. et al. (2011). Is the Montreal Cognitive Assessment superior to the Mini-Mental State Examination to detect poststroke cognitive impairment? A study with neuropsychological evaluation. Stroke, 42, 17121716.CrossRefGoogle Scholar
Gorelick, P. B. et al. (2011). Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42, 26722713.CrossRefGoogle ScholarPubMed
Hachinski, V. et al. (2006). National Institute of Neurological Disorders and Stroke–Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke, 37, 22202241.CrossRefGoogle ScholarPubMed
Hanley, J. A. and McNeil, B. J. (1983). A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology, 148, 839843.CrossRefGoogle ScholarPubMed
Hindmarch, I. et al. (1998). The Bayer Activities of Daily Living Scale (B-ADL). Dementia and Geriatric Cognitive Disorders, 9, 2026.CrossRefGoogle Scholar
Narasimhalu, K. et al. (2009). Severity of CIND and MCI predict incidence of dementia in an ischemic stroke cohort. Neurology, 73, 18661872.CrossRefGoogle Scholar
Narasimhalu, K. et al. (2011). The prognostic effects of poststroke cognitive impairment no dementia and domain-specific cognitive impairments in nondisabled ischemic stroke patients. Stroke, 42, 883888.CrossRefGoogle ScholarPubMed
Nasreddine, Z. S. et al. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695699.CrossRefGoogle ScholarPubMed
Pendlebury, S. T., Mariz, J., Bull, L., Mehta, Z. and Rothwell, P. M. (2012). MoCA, ACE-R, and MMSE versus the National Institute of Neurological Disorders and Stroke–Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Neuropsychological Battery after TIA and stroke. Stroke, 43, 464469.CrossRefGoogle ScholarPubMed
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183194.CrossRefGoogle ScholarPubMed
Porteus, S. D. (1959). The Maze Test and Clinical Psychology. Palo Alto, CA: Pacific Books.CrossRefGoogle Scholar
Rockwood, K., Wentzel, C., Hachinski, V., Hogan, D. B., MacKnight, C. and McDowell, I. (2000). Prevalence and outcomes of vascular cognitive impairment. Neurology, 54, 447451.CrossRefGoogle ScholarPubMed
Rossetti, H. C., Lacritz, L. H., Cullum, C. M. and Weiner, M. F. (2011). Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample. Neurology, 77, 12721275.CrossRefGoogle Scholar
Smith, A. (1973). Symbol Digit Modalities Test. Los Angeles, CA: Western Psychological Services.Google Scholar
Strauss, E., Sherman, M. S. and Spreen, O. (2006). A Compendium of Neuropsychological Tests. New York: Oxford University Press.Google Scholar
Tham, W. et al. (2002). Progression of cognitive impairment after stroke: one year results from a longitudinal study of Singaporean stroke patients. Journal of Neurological Sciences, 203–204, 4952.CrossRefGoogle ScholarPubMed
Wong, A. et al. (2009). The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dementia and Geriatric Cognitive Disorders, 28, 8187.CrossRefGoogle Scholar
Yeo, D., Gabriel, C., Chen, C., Lee, S., Loenneker, T. and Wong, M. (1997). Pilot validation of a customized neuropsychological battery in elderly Singaporeans. Neurological Journal of South East Asia, 2, 123.Google Scholar
Supplementary material: File

Dong Supplementary Material

Supplementary Material

Download Dong Supplementary Material(File)
File 108 KB
Supplementary material: File

Dong Supplementary Material

Supplementary Material

Download Dong Supplementary Material(File)
File 109 KB
24
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Improving screening for vascular cognitive impairment at three to six months after mild ischemic stroke and transient ischemic attack
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Improving screening for vascular cognitive impairment at three to six months after mild ischemic stroke and transient ischemic attack
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Improving screening for vascular cognitive impairment at three to six months after mild ischemic stroke and transient ischemic attack
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *