Evaluation of the Mini-Mental State Examination and the Montreal Cognitive Assessment for Predicting Post-stroke Cognitive Impairment During the Acute Phase in Chinese Minor Stroke Patients

Yueli Zhu,Ziqi Fan,Win Topatana,Fan He,Yaping Yan,Shuai Zhao,Baorong Zhang,Yanxing Chen,Zheyu Li,Zhirong Liu,Caixiu Lin

doi:10.3389/fnagi.2020.00236

Abstract

Objective: To assess the value of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) during acute phase in predicting post-stroke cognitive impairment (PSCI) at 3–6 months.Methods: We prospectively recruited 229 patients who had suffered their first-ever ischemic stroke. PSCI was determined in 104 of these patients by a comprehensive neuropsychological battery performed at 3–6 months. Receiver operating characteristic (ROC) curve analysis was then performed to compare the discriminatory ability of the MMSE and MoCA. Also, we applied a decision tree generated by the classification and regression tree methodology.Results: In total, 66 patients had PSCI when evaluated 3–6 months after the onset of minor stroke. Logistic regression analysis revealed that education, body mass index (BMI), and baseline MoCA scores were independently associated with PSCI. ROC curve analysis showed that the ability to predict PSCI was similar when compared between baseline MoCA scores [area under curve (AUC), 0.821; 95% confidence interval (CI), 0.743–0.898] and baseline MMSE scores (AUC, 0.809; 95% CI, 0.725–0.892, P = 0.75). Both MMSE and MoCA exhibited similar predictive values at their optimal cut-off points (MMSE ≤27; sensitivity, 0.682; specificity, 0.816; MoCA ≤21; sensitivity, 0.636; specificity, 0.895). Classification and regression tree-derived analysis yielded an AUC of 0.823 (sensitivity, 0.803; specificity, 0.842).Conclusion: When applied within 2 weeks of stroke, the MMSE and MoCA are both useful and have similar predictive value for PSCI 3–6 months after the onset of minor stroke.

Highlights

Cognitive impairment is a common sequel after stroke and is known to be associated with poor functional outcomes and even death (Oksala et al, 2009; Gottesman and Hillis, 2010; Jokinen et al, 2015)
There is an urgent need to develop methods that are capable of identifying patients who are at risk of Post-stroke cognitive impairment (PSCI), in the acute phase after stroke
There were no significant differences between patients with or without follow-up in the baseline characteristics, including sex, education, body mass index (BMI), baseline Mini-Mental State Examination (MMSE) scores, and baseline Montreal Cognitive Assessment (MoCA) scores (Supplementary Table S1)

Summary

Introduction

Cognitive impairment is a common sequel after stroke and is known to be associated with poor functional outcomes and even death (Oksala et al, 2009; Gottesman and Hillis, 2010; Jokinen et al, 2015). The assessment of cognitive function in the acute phase of stroke can help predict and early identify PSCI patients. Timely intervention for these patients may slow the progression of cognitive impairment. The American Heart Association/American Stroke Association recommended that all stroke patients should be screened for cognitive deficits before discharge (Winstein et al, 2016). There is an urgent need to develop methods that are capable of identifying patients who are at risk of PSCI, in the acute phase after stroke

Methods

Results

Conclusion