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Screening for Cognitive Impairment in a Stroke Prevention Clinic Using the MoCA

Published online by Cambridge University Press:  23 September 2014

Lauren M. Mai ,
Wieslaw Oczkowski ,
Gail Mackenzie ,
Anatoly Shuster ,
Lauren Wasielesky ,
Arlene Franchetto ,
Michael Patlas  and
Demetrios J. Sahlas
Lauren M. Mai
Affiliation:
Department of Clinical Neurological Sciences, Western University, London
Wieslaw Oczkowski
Affiliation:
Division of Neurology, Department of Medicine, McMaster University Central South Ontario Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
Gail Mackenzie
Affiliation:
Central South Ontario Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
Anatoly Shuster
Affiliation:
Department of Radiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
Lauren Wasielesky
Affiliation:
Department of Radiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
Arlene Franchetto
Affiliation:
Department of Radiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
Michael Patlas
Affiliation:
Department of Radiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
Demetrios J. Sahlas*
Affiliation:
Division of Neurology, Department of Medicine, McMaster University Central South Ontario Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
*
Hamilton General Hospital, Room 706, McMaster Wing, 237 barton Street east, Hamilton, Ontario, L8L 2X2, Canada. email: sahlas@mcmaster.ca.
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Abstract

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Background:

Screening for cognitive impairment is recommended in patients with cerebrovascular disease. We sought to establish the incidence of cognitive impairment using the Montreal Cognitive Assessment (MoCA) in a cohort of consecutive patients attending our stroke prevention clinic (SPC), and to determine whether a subset of the MoCA could be derived for use in this busy clinical setting.

Methods:

The MoCA was administered to 102 patients. Incidence of cognitive impairment was compared to presenting complaint and final diagnosis. extent of cerebral white matter changes (WMC) was rated using the Age Related White Matter Changes (ARWMC) scale in 80 patients who underwent neuroimaging. A subset of the three most predictive test elements of the MoCA was derived using regression analysis.

Results:

63.7% of patients scored <26/30 on the MoCA, in keeping with cognitive impairment. This was unrelated to the final diagnosis or extent of WMC, although a trend for lower MoCA scores was observed in older patients. A mini-MoCA subscore combining the clock drawing test, five-word delayed recall, and abstraction was highly correlated with the final MoCA score (R=0.901). A score of <7/10 using this 10-point mini-MoCA identified cognitive impairment as defined by the MoCA with a sensitivity of 98.5%, and a specificity of 77.6%.

Conclusions:

Two-thirds of SPC patients demonstrated evidence for cognitive impairment, irrespective of their final diagnosis or the presence of WMC. A mini-MoCA comprised of the clock drawing test, five-word delayed recall, and abstraction represents a potential alternative to the full MoCA in this population.

Résumé:

Résumé:Contexte:

Le dépistage d'un déficit cognitif est recommandé chez les patients atteints d'une maladie cérébrovasculaire. Notre but était d'évaluer l'incidence du déficit cognitif au moyen du test d'évaluation cognitive de Montréal (MoCa) dans une cohorte de patients consécutifs fréquentant notre clinique de prévention de l'accident vasculaire cérébral (CPAVC) et de déterminer si une forme abrégée du test MoCA pourrait être élaborée pour utilisation dans le contexte d'une clinique très achalandée.

Méthode:

Le MoCa a été utilisé chez 102 patients. L'incidence de déficit cognitif a été comparé au motif de consultation et au diagnostic fmal. L'ampleur des changements au niveau de la substance blanche (SB) a été évaluée au moyen de l'échelle Age Related White Matter Changes (ARWMC) chez 80 patients qui ont subi une neuroimagerie. Un sous-groupe des trois éléments les plus prédictifs de l'échelle MoCA ont été identifiés au moyen d'une analyse de régression.

Résultats:

63,7% des patients ont obtenu un score de moins de 26 sur 30 au MoCA, ce qui témoigne de la présence d'un déficit cognitif. Cette observation n'était pas reliée au diagnostic fmal ou à l'ampleur des changements au niveau de la substance blanche. Un score au mini-MoCA constitué du test du dessin de l'horloge, du rappel retardé de cinq mots et de l'abstraction était hautement corrélé au score fmal du MoCA (R = 0,901). Un score de moins de 7 sur 10 à ce mini-MoCA de 10 points identifiait un déficit cognitif tel que défmi par le MoCA, avec une sensibilité de 98,5% et une spécificité de 77,6%.

Conclusions:

Les deux-tiers des patients de la CPAVC avaient des signes de déficit cognitif, quelque soit leur diagnostic fmal ou la présence de changements au niveau de la SB. Un mini-MoCA constitué du test du dessin de l'horloge, du rappel retardé de cinq mots et de l'abstraction pourrait être une alternative au test MoCA complet dans cette population.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 2 , March 2013 , pp. 192 - 197
Copyright
Copyright © The Canadian Journal of Neurological 2013

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