Improving Screening for Vascular Cognitive Impairment at 3–6 Months after Ischemic Stroke
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1
UNSW Medicine, the University of New South Wales, Psychiatry, Australia
Background: A sensitive screening instrument for Vascular Cognitive Impairment (VCI) at the early convalescent phase of stroke, i.e., 3–6 months after stroke, needs to be established. We compared the MoCA and MMSE, with and without the addition of a brief processing speed test, the symbol digit modalities test (SDMT), for VCI screening.
Methods: Patients with ischemic stroke and transient ischemic attack were assessed with MoCA, MMSE and a formal neuropsychological battery 3–6 months after stroke. VCI was defined by impairment in any cognitive domain on neuropsychological testing. Area under the receiver operating characteristic curve (AUC) was used to compare test discriminatory ability.
Results: 189 of 327 patients (58%) had VCI, of whom the majority, 180 (95%), had vascular Mild Cognitive Impairment (VaMCI) and 9 (5%) had dementia. The overall AUCs of MoCA and MMSE scores and performance at their respective cutoff points were equivalent in detecting VCI (AUCs: 0.87 [95% CI 0.83–0.91] vs. 0.84 [95% CI 0.80–0.88], p = 0.13; Cutoffs: MoCA (≤23) vs. MMSE (≤26), sensitivity: 0.78 vs. 0.71; specificity: 0.80 vs. 0.82; positive predictive value: 0.84 vs. 0.84; negative predictive value: 0.72 vs. 0.67; correctly classified 78.6% vs. 75.5%; p = 0.42).The AUCs of MMSE and MoCA were improved significantly by the SDMT (AUCs: MMSE+SDMT 0.90 [95% CI 0.87–0.93], p
Keywords:
MMSE,
MOCA,
Symbol Digit Modalities Test,
vascular cognitive impairment,
Mild Cognitive Impairment,
Stroke,
Cognitive screening
Conference:
ACNS-2013 Australasian Cognitive Neuroscience Society Conference, Clayton, Melbourne, Australia, 28 Nov - 1 Dec, 2013.
Presentation Type:
Poster
Topic:
Other
Citation:
Dong
C and
Slavin
MJ
(2013). Improving Screening for Vascular Cognitive Impairment at 3–6 Months after Ischemic Stroke.
Conference Abstract:
ACNS-2013 Australasian Cognitive Neuroscience Society Conference.
doi: 10.3389/conf.fnhum.2013.212.00051
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Received:
15 Oct 2013;
Published Online:
25 Nov 2013.
*
Correspondence:
Ms. Catherine Yanhong Dong, UNSW Medicine, the University of New South Wales, Psychiatry, Sydney, Australia, cathdong03@yahoo.com.sg