ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurorehabilitation
Significance of the Boston Cognitive Assessment in patients with chronic post-stroke cognitive impairment
Provisionally accepted
- 1The third Affiliated Hospital of Soochow University, The First People’s Hospital of Changzhou, Changzhou, China
- 2Department of Rehabilitation Jiangsu Rongjun Hospital, Wuxi, China
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Background: The Boston Cognitive Assessment (BoCA) is an online, self-administered, remote cognitive screening tool for the early detection and long-term monitoring of brain health changes in aging populations. This study aimed to evaluate the reliability and validity of the Mandarin version of the BoCA in Chinese patients with stroke, providing a reference for important clinical application. Methods: This study included 120 patients with chronic stroke and 120 healthy controls. All participants completed the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Mandarin versions of the BoCA. Assessments were spaced a minimum of 60 minutes apart. For the test–retest reliability analysis, 120 patients with stroke were retested on the BoCA after 1 week. Receiver operating characteristic (ROC) curves were generated to assess diagnostic performance. Results: Among the stroke group, the BoCA showed appreciable internal consistency (Cronbach's α=0.808) and significant test–retest reliability (intraclass correlation coefficient, ICC=0.895, p<0.001). The BoCA subscales demonstrated moderate-to-strong correlations with the total score (r=0.546–0.770), supporting adequate content validity. The BoCA total scores correlated strongly with the MMSE (r=0.829, p<0.001) and MoCA scores (r=0.848, p<0.001), demonstrating adequate criterion-related validity. Exploratory factor analysis of the BoCA tasks revealed one robust factor accounting for a plurality (i.e., 46.9%) of the total variance, indicating sufficient construct validity. ROC analysis revealed comparable diagnostic performance for the BoCA (area under the curve, AUC=0.823), MMSE (AUC=0.836), and MoCA (AUC=0.818). A BoCA score of 23.5 distinguished the stroke group from the control group with 81.7% sensitivity and 69.2% specificity. Conclusions: The Mandarin version of the BoCA exhibits significant reliability and validity and functions effectively as a supplementary measure for cognitive assessment in stroke survivors.
Keywords: Boston Cognitive Assessment, Brain health, Stroke, impairment, cerebral vasculardisorder
Received: 21 Aug 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Yin, Zhu, Ji, Zhang and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yi Zhang, zhangyizhe1975@163.com
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