Methods for Improving Screening for Vascular Cognitive Impairment Using the Montreal Cognitive Assessment Journal Articles uri icon

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  • ABSTRACT:Background:Vascular cognitive impairment (VCI) post-stroke is frequent but may go undetected, which highlights the need to better screen cognitive functioning following a stroke.Aim:We examined the clinical utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment against a gold-standard neuropsychological battery.Methods:We assessed cognitive status with a comprehensive battery of neuropsychological tests in 161 individuals who were at least 3-months post-stroke. We used receiver operating characteristic (ROC) curves to identify two cut points for the MoCA to maximize sensitivity and specificity at a minimum 90% threshold. We examined the utility of the Symbol Digit Modalities Test, a processing speed measure, to determine whether this additional metric would improve classification relative to the MoCA total score alone.Results:Using two cut points, 27% of participants scored ≤ 23 and were classified as high probability of cognitive impairment (sensitivity 92%), and 24% of participants scored ≥ 28 and were classified as low probability of cognitive impairment (specificity 91%). The remaining 48% of participants scored from 24 to 27 and were classified as indeterminate probability of cognitive impairment. The addition of a processing speed measure improved classification for the indeterminate group by correctly identifying 65% of these individuals, for an overall classification accuracy of 79%.Conclusions:The utility of the MoCA in detecting cognitive impairment post-stroke is improved when using a three-category approach. The addition of a processing speed measure provides a practical and efficient method to increase confidence in the determined outcome while minimally extending the screening routine for VCI.


  • Zaidi, Khush-Bakht
  • Rich, Jill B
  • Sunderland, Kelly M
  • Binns, Malcolm A
  • Truong, Linda
  • McLaughlin, Paula M
  • Pugh, Bradley
  • Kwan, Donna
  • Beaton, Derek
  • Levine, Brian
  • Sahlas, Demetrios
  • Dowlatshahi, Dariush
  • Hassan, Ayman
  • Mandzia, Jennifer
  • Troyer, Angela K
  • Swartz, Richard H

publication date

  • November 2020