Vera Zietemann1, Marios K Georgakis1, Thibaut Dondaine1, Claudia Müller1, Anne-Marie Mendyk1, Anna Kopczak1, Hilde Hénon1, Stéphanie Bombois1, Frank Arne Wollenweber1, Régis Bordet1, Martin Dichgans2. 1. From the Institute for Stroke and Dementia Research (V.Z., M.K.G., C.M., A.K., F.A.W., M.D.), University Hospital, Ludwig-Maximilians-University, Munich, Germany; University of Lille (T.D., A.-M.M., H.H., S.B., R.B.), Inserm, CHU Lille, "Degenerative and Vascular Cognitive Disorders", Lille, France; German Centre for Neurodegenerative Diseases (M.D.); and Munich Cluster for Systems Neurology (M.D.), Germany. 2. From the Institute for Stroke and Dementia Research (V.Z., M.K.G., C.M., A.K., F.A.W., M.D.), University Hospital, Ludwig-Maximilians-University, Munich, Germany; University of Lille (T.D., A.-M.M., H.H., S.B., R.B.), Inserm, CHU Lille, "Degenerative and Vascular Cognitive Disorders", Lille, France; German Centre for Neurodegenerative Diseases (M.D.); and Munich Cluster for Systems Neurology (M.D.), Germany. martin.dichgans@med.uni-muenchen.de.
Abstract
OBJECTIVE: To examine whether the Montreal Cognitive Assessment (MoCA) administered within 7 days after stroke predicts long-term cognitive impairment, functional impairment, and mortality. METHODS: MoCA was administered to 274 patients from 2 prospective hospital-based cohort studies in Germany (n = 125) and France (n = 149). Cognitive and functional outcomes were assessed at 6, 12, and 36 months after stroke by comprehensive neuropsychological testing, the Clinical Dementia Rating (CDR) scale, the modified Rankin Scale (mRS), and Instrumental Activities of Daily Living (IADL) and analyzed with generalized estimating equations. All-cause mortality was investigated by Cox proportional hazard models. Analyses were adjusted for demographic variables, education, vascular risk factors, premorbid cognitive status, and NIH Stroke Scale scores. The additive predictive value of MoCA was examined with receiver operating characteristic curves. RESULTS: In pooled analyses, a baseline MoCA score <26 was associated with cognitive impairment, defined by neuropsychological testing (odds ratio [OR] 5.30, 95% confidence interval [CI] 2.75-10.22) and by CDR score ≥0.5 (OR 2.53, 95% CI 1.53-4.18); functional impairment, defined by mRS score >2 (OR 5.03, 95% CI 2.20-11.51) and by IADL score <8 (OR 2.48, 95% CI 1.40-4.38); and mortality (hazard ratio 7.24, 95% CI 1.99-26.35) across the 3-year follow-up. Patients with MoCA score <26 performed worse across all prespecified cognitive domains (executive function/attention, memory, language, visuospatial ability). MoCA increased the area under the curve for predicting cognitive impairment (neuropsychological testing 0.81 vs 0.72, p = 0.01) and functional impairment (mRS score >2, 0.88 vs 0.84, p = 0.047). CONCLUSION: Early cognitive testing by MoCA predicts long-term cognitive outcome, functional outcome, and mortality after stroke. Our results support routine use of the MoCA in stroke patients.
OBJECTIVE: To examine whether the Montreal Cognitive Assessment (MoCA) administered within 7 days after stroke predicts long-term cognitive impairment, functional impairment, and mortality. METHODS: MoCA was administered to 274 patients from 2 prospective hospital-based cohort studies in Germany (n = 125) and France (n = 149). Cognitive and functional outcomes were assessed at 6, 12, and 36 months after stroke by comprehensive neuropsychological testing, the Clinical Dementia Rating (CDR) scale, the modified Rankin Scale (mRS), and Instrumental Activities of Daily Living (IADL) and analyzed with generalized estimating equations. All-cause mortality was investigated by Cox proportional hazard models. Analyses were adjusted for demographic variables, education, vascular risk factors, premorbid cognitive status, and NIH Stroke Scale scores. The additive predictive value of MoCA was examined with receiver operating characteristic curves. RESULTS: In pooled analyses, a baseline MoCA score <26 was associated with cognitive impairment, defined by neuropsychological testing (odds ratio [OR] 5.30, 95% confidence interval [CI] 2.75-10.22) and by CDR score ≥0.5 (OR 2.53, 95% CI 1.53-4.18); functional impairment, defined by mRS score >2 (OR 5.03, 95% CI 2.20-11.51) and by IADL score <8 (OR 2.48, 95% CI 1.40-4.38); and mortality (hazard ratio 7.24, 95% CI 1.99-26.35) across the 3-year follow-up. Patients with MoCA score <26 performed worse across all prespecified cognitive domains (executive function/attention, memory, language, visuospatial ability). MoCA increased the area under the curve for predicting cognitive impairment (neuropsychological testing 0.81 vs 0.72, p = 0.01) and functional impairment (mRS score >2, 0.88 vs 0.84, p = 0.047). CONCLUSION: Early cognitive testing by MoCA predicts long-term cognitive outcome, functional outcome, and mortality after stroke. Our results support routine use of the MoCA in strokepatients.
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