Letter by Regal Regarding Article, “Serial Montreal Cognitive Assessments Demonstrate Reversible Cognitive Impairment in Patients With Acute Transient Ischemic Attack and Minor Stroke”

Sivakumar et al1 performed an important study of serial improvements by cognitive domain in 100 patients with transient ischemic attack (TIA) or minor ischemic stroke (National Institutes of Health Stroke Scale <3/42). We think that all forms of rapid cognitive decline should be in the same category, which contrasts with the slow cognitive decline of dementia and mild cognitive impairment. They grouped Montreal Cognitive Assessment2 (MoCA) test items by cognitive domain, a vastly superior approach than just considering global MoCA score. The domain of greatest interest for comparison with delirium is attention, represented by 4 MoCA tests: (1) 5-digit span forward (5-DSF)—attention <5 seconds; (2) 3-digit span backward (3-DSB)—attention <5 seconds; (3) vigilance test for A—15 seconds, impaired only in severe inattention; (4) serial 7 subtraction from 100—measure of sustained attention and executive function. Serial 7 subtraction is poor in low …