Accuracy of the Montreal Cognitive Assessment in Detecting Cognitive Impairment Following Stroke
Zaidi, Syeda Khush-Bakht
MetadataShow full item record
Vascular cognitive impairment (VCI) post stroke is frequent, but may go undetected, which highlights the need to better screen cognitive functioning post stroke. We sought to examine the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA), a cognitive screening measure recommended for use with stroke populations. We assessed cognitive status in 161 individuals who were at least 3 months post stroke with a comprehensive battery of neuropsychological measures. We compared diagnostic accuracy using a single cut point compared to two cut points and determined that sensitivity and specificity were optimal when two cut points were applied. This resulted in three groups, where 27% of participants scored 23 and were classified as high likelihood of cognitive impairment, and 25% of participants scored 28 and were classified as low likelihood of cognitive impairment. The remaining 47% of participants scored from 24 to 27 and were classified as indeterminate likelihood of cognitive impairment. The addition of a processing speed measure improved classification for this group by correctly classifying 71% of the individuals in this category. We provide a three-category diagnostic approach to better identify individuals as certain and uncertain likelihood of cognitive impairment. The addition of a processing speed measure provides a practical and efficient method to increase confidence in the determined outcome, while also expanding the utility of the MoCA.