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Improving screening for vascular cognitive impairment at three to six months after mild ischemic stroke and transient ischemic attack

Published online by Cambridge University Press:  15 January 2014

YanHong Dong ,
Melissa Jane Slavin ,
Bernard Poon-Lap Chan ,
Narayanaswamy Venketasubramanian ,
Vijay Kumar Sharma ,
Simon Lowes Collinson ,
Perminder Singh Sachdev  and
Christopher Li-Hsian Chen
YanHong Dong
Affiliation:
Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia
Melissa Jane Slavin
Affiliation:
Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia
Bernard Poon-Lap Chan
Affiliation:
Department of Medicine, National University Health System, Singapore
Narayanaswamy Venketasubramanian
Affiliation:
Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore Department of Medicine, National University Health System, Singapore Neuroscience Clinic, Raffles Hospital, Singapore
Vijay Kumar Sharma
Affiliation:
Department of Medicine, National University Health System, Singapore
Simon Lowes Collinson
Affiliation:
Department of Psychology, National University of Singapore, Singapore
Perminder Singh Sachdev
Affiliation:
Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia
Christopher Li-Hsian Chen*
Affiliation:
Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore
*
Correspondence should be addressed to: Dr. Christopher Li-Hsian Chen, MD, Clinical Research Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, MD11, Level 5, #05-9, 10 Medical Drive, Singapore117597. Phone: +65-65165885; Fax: +65-68724101. Email: phccclh@nus.edu.sg.
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Abstract

Background:

The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were compared with and without the addition of a brief processing speed test, the symbol digit modalities test (SDMT), for vascular cognitive impairment (VCI) screening at three to six months after stroke.

Methods:

Patients with ischemic stroke and transient ischemic attack were assessed with MoCA and MMSE, as well as a formal neuropsychological battery three to six months after stroke. VCI was defined by impairment in any cognitive domain on neuropsychological testing. The area under the receiver operating characteristic curve (AUC) was used to compare test discriminatory ability.

Results:

One hundred and eighty-nine patients out of 327 (58%) had VCI, of whom 180 (95%) had vascular mild cognitive impairment (VaMCI), and nine (5%) had dementia. The overall AUCs of the MoCA and MMSE scores and performance at their respective cut-off points were equivalent in detecting VCI (AUCs: 0.87 (95% CI 0.83–0.91) vs. 0.84 (95% CI 0.80–0.88), p = 0.13; cut-offs: MoCA (≤23) vs. MMSE (≤26), sensitivity: 0.78 vs. 0.71; specificity: 0.80 vs. 0.82; positive predictive value: 0.84 vs. 0.84; negative predictive value: 0.72 vs. 0.67; and correctly classified 78.6% vs. 75.5%; p = 0.42). The AUCs of MMSE and MoCA were improved significantly by the SDMT (AUCs: MMSE+SDMT 0.90 (95% CI 0.87–0.93), p <0.001; MoCA+SDMT 0.91 (95% CI 0.88–0.94), p < 0.02).

Conclusions:

The MoCA and MMSE are equivalent and moderately sensitive, and can be supplemented with the SDMT to improve their accuracy in VCI screening.

Keywords

cognitive screeningmini-mental state examination (MMSE)montreal cognitive assessment (MoCA)symbol digit modalities test (SDMT)vascular cognitive impairment (VCI)mild cognitive impairment (MCI)stroke
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 5 , May 2014 , pp. 787 - 793
Copyright
Copyright © International Psychogeriatric Association 2014 

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