Screening for cognitive impairment after stroke: A systematic review of psychometric properties and clinical utility.

OBJECTIVE: To systematically review the psychometric properties and clinical utility of cognitive screening tools post-stroke. DATA SOURCES: EMBASE, CINAHL, MEDLINE, PsychInfo. STUDY SELECTION: Studies testing the accuracy of screening tools for cognitive impairment after stroke. DATA EXTRACTION: Data regarding the participants, selection criteria, criterion/reference measure, cut-off score, sensitivity, specificity and positive and negative predicted values for the selected tools were extracted. Tools with sensitivity ≥ 80% and specificity ≥ 60% were selected. Clinical utility was assessed using a previously validated tool and those scoring <6 were excluded. DATA SYNTHESIS: Twenty-one papers regarding 12 screening tools were selected. Only the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE) met all psychometric and clinical utility criteria for any levels of cognitive impairment. However, the MMSE is most accurate to screen for dementia (cut-off score 23/24) and should only be used for this purpose. In addition, the following can be used to detect: • Any impairment: Addenbrooke's Cognitive Examination-Revised (ACE-R), Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and Cognistat. • Multiple-domain impairments: ACE-R, Telephone-MoCA or modified Telephone Interview for Cognitive Status (TICS). • Dementia: TICS; Cambridge Cognitive Examination; Rotterdam-Cambridge Cognitive Examination; Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) and short-IQCODE. The IQCODE and short-IQCODE are useful when the patient is unable to respond and an informant's view is required.
CONCLUSION: The MoCA is the most valid and clinically feasible screening tool to identify stroke survivors with a wide range of cognitive impairments who warrant further assessment.