Abstract
Cognitive assessments after stroke are typically short form tests developed for dementia that generates pass/fail classifications (e.g. the MoCA). The Oxford Cognitive Screen (OCS) provides a domain-specific cognitive profile designed for stroke survivors. This study compared the use of the MoCA and the OCS in acute stroke with respect to symptom specificity and aspects of clinical utility. A cross-sectional study with a consecutive sample of 200 stroke patients within 3 weeks of stroke completing MoCA and OCS. Demographic data, lesion side and Barthel scores were recorded. Inclusivity was assessed in terms of completion rates and reasons for non-completion were evaluated. The incidence of cognitive impairments on both the MoCA and OCS sub-domains was calculated and differences in stroke specificity, cognitive profiles and independence of the measures were addressed. The incidence of acute cognitive impairment was high: 76 % of patients were impaired on MoCA, and 86 % demonstrated at least one impairment on the cognitive domains assessed in the OCS. OCS was more sensitive than MoCA overall (87 vs 78 % sensitivity) and OCS alone provided domain-specific information on prevalent post-stroke cognitive impairments (neglect, apraxia and reading/writing ability). Unlike the MOCA, the OCS was not dominated by left hemisphere impairments but gave differentiated profiles across the contrasting domains. The OCS detects important cognitive deficits after stroke not assessed in the MoCA, it is inclusive for patients with aphasia and neglect and it is less confounded by co-occurring difficulties in these domains.
Highlights
Following stroke, cognitive deficits are frequent [1,2,3,4], predictive of recovery [5,6,7,8,9,10,11,12] and interfere with rehabilitation
The incidence of acute cognitive impairment was high: 76 % of patients were impaired on Montreal Cognitive Assessment (MoCA), and 86 % demonstrated at least one impairment on the cognitive domains assessed in the Oxford Cognitive Screen (OCS)
For the OCS domain of praxis, all the patients excluded on the majority of MoCA were able to complete the task and returned scores, with 36 % (N = 5) not demonstrating any praxic impairment
Summary
Cognitive deficits are frequent [1,2,3,4], predictive of recovery [5,6,7,8,9,10,11,12] and interfere with rehabilitation (e.g. due to poor comprehension or spatial attention). Cognitive deficits after stroke are associated with a reduced quality of life [13,14,15] and depression [8]. Due to their prevalence and importance, early detection is required to facilitate rehabilitation. Though developed for dementia, the MoCA has been shown to have better sensitivity in detecting post-stroke cognitive impairments than the traditionally used Mini-Mental Status Examination (MMSE) [18,19,20,21]. Neither the MMSE nor the MOCA assesses common post-stroke domain-specific impairments including aphasia, visual loss, visuo-spatial inattention (neglect), apraxia and reading/writing problems.
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