Premium
Montreal Cognitive Assessment and Mini–Mental State Examination are both valid cognitive tools in stroke
Author(s) -
Cumming T. B.,
Churilov L.,
Linden T.,
Bernhardt J.
Publication year - 2013
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12084
Subject(s) - montreal cognitive assessment , mini–mental state examination , stroke (engine) , cognition , medicine , neuropsychology , cognitive impairment , receiver operating characteristic , physical therapy , psychology , audiology , psychiatry , mechanical engineering , engineering
Objective To determine the validity of the M ontreal C ognitive A ssessment ( M o CA ) and the M ini– M ental S tate E xamination ( MMSE ) as screening tools for cognitive impairment after stroke. Materials and methods Cognitive assessments were administered over 2 sessions (1 week apart) at 3 months post‐stroke. Scores on the M o CA and MMSE were evaluated against a diagnosis of cognitive impairment derived from a comprehensive neuropsychological battery (the criterion standard). Results Sixty patients participated in the study [mean age 72.1 years ( SD = 13.9), mean education 10.5 years ( SD = 3.9), median acute NIHSS score 5 ( IQR 3–7)]. The Mo CA yielded lower scores (median = 21, IQR = 17–24; mean = 20.0, SD = 5.4) than the MMSE (median = 26, IQR = 22–27; mean = 24.2, SD = 4.5). MMSE data were more skewed towards ceiling than M o CA data (skewness = −1.09 vs −0.73). Area under the receiver operator curve was higher for M o CA than for MMSE (0.87 vs 0.84), although this difference was not significant (χ 2 = 0.48, P = 0.49). At their optimal cut‐offs, the M o CA had better sensitivity than the MMSE (0.92 vs 0.82) but poorer specificity (0.67 vs 0.76). Conclusions The Mo CA is a valid screening tool for post‐stroke cognitive impairment; it is more sensitive but less specific than the MMSE . Contrary to the prevailing view, the MMSE also exhibited acceptable validity in this setting.