Decline in changing Montreal Cognitive Assessment (MoCA) scores is associated with post-stroke cognitive decline determined by a formal neuropsychological evaluation.

Hui Hui Tan,Yanhong Dong,Raymond Chee Seong Seet,Vijay Kumar Sharma,Jing Xu,Narayanaswarmy Venketasubramanian,Christopher Li-Hsian Chen,Hock Luen Teoh,Bernard Poon-Lap Chan,Masaki Mogi

doi:10.1371/journal.pone.0173291

Abstract

ObjectivesWe aimed to examine changes in the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scores within a one-year period after stroke/transient ischemic attack (TIA) in associating cognitive decline determined by a formal neuropsychological test battery.MethodsPatients with ischemic stroke/TIA received MoCA and MMSE at baseline within 14 days after stroke/TIA, at 3–6 months and 1-year follow-ups. The scores of MoCA and MMSE were considered to have declined if there were a reduction of ≥2 points in the respective scores measured across two time points. The decline in neuropsychological diagnosis transitional status was defined by a category transition from no cognitive impairment or any cognitive impairment to a more severe cognitive impairment or dementia.Results275 patients with a mean age of 59.8 ± 11.6 years, and education of 7.7 ± 4.3 years completed all the assessments at baseline, 3–6 months and 1-year follow-ups. A decline in MoCA scores from 3–6 months to 1 year was associated with higher risk of decline in diagnosis transitional status (odd ratio = 3.21, p = 0.004) in the same time period whereas there was no association with a decline in MMSE scores.ConclusionsThe decline in MoCA scores from 3–6 months to 1 year after stroke/TIA has three times higher risk for decline in the diagnosis transitional status. The decline of MoCA scores (reduction ≥ 2points) is associated with the decline in neuropsychological diagnosis transitional status.

Highlights

Cognitive deficits are common after stroke with 10% of patients developing dementia after their first-ever stroke and more than 30% had dementia after recurrent stroke [1]
A decline in Montreal Cognitive Assessment (MoCA) scores from 3–6 months to 1 year was associated with higher risk of decline in diagnosis transitional status in the same time period whereas there was no association with a decline in MiniMental State Examination (MMSE) scores
Declining MoCA scores associated with formal diagnosis of post-stroke cognitive decline

Summary

Introduction

Cognitive deficits are common after stroke with 10% of patients developing dementia after their first-ever stroke and more than 30% had dementia after recurrent stroke [1]. Post-stroke dementia includes vascular dementia (VaD) among others. Vascular cognitive impairment with no dementia (VCIND) is even more prevalent in post-stroke patients, with a reported rate of 47.7% [2]. Both VCIND and VaD are considered part of the spectrum of vascular cognitive impairment (VCI) [3]. The prognosis of VCI is poor, with higher mortality rate and poorer functional outcome as compared to patients without cognitive impairment [4]. The severity of VCIND differentially predicts survival such that moderate VCIND patients are 3–4 times more likely to die than mild VCIND patients and those without cognitive impairment within the follow-up period of 5 years [4]

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