Screening and facilitating further assessment for cognitive impairment after stroke: application of a shortened Montreal Cognitive Assessment (miniMoCA)

PURPOSE: The purpose of this study is to examine the performance of a shortened version of the MoCA (miniMoCA), as a clinical cognitive impairment screening tool in stroke rehabilitation patients. METHODS: Cognitive status was assessed using the MoCA and Cognistat in 72 patients. Agreement between the tests was assessed using the Kappa statistic. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of a miniMoCA to a MoCA score <26 was also examined. RESULTS: A significant level of agreement was found between the MoCA and miniMoCA to the Cognistat in classifying patients by level of cognitive function. The miniMoCA showed a sensitivity of 93% and specificity of 92% (PPV 98%, NPV 75%) to abnormal MoCA scores (<26). CONCLUSIONS: This study extends the utility of the miniMoCA as an optimal brief screening tool for cognitive impairment in stroke patients. Further research is needed to determine the validity of the miniMoCA against a neuropsychological test. IMPLICATIONS FOR REHABILITATION: Although the Montreal Cognitive Assessment (MoCA) is a recommended tool to screen for cognitive impairment in stroke patients, its lengthy administration can lead to inconsistent screening of patients for post-stroke cognitive function. In the current work, a shortened version of the MoCA (miniMoCA) was administered in a sample of stoke inpatients, utilizing only five of the eight original subtests. The proposed miniMoCA was found to streamline the administration of this screen test, while maintaining a heightened level of sensitivity for accurately identifying which patients do not require a more in-depth cognitive assessment.