Article

OBJECTIVES: To compare Montreal Cognitive Assessment (MoCA) and Mini-Mental State
Examination (MMSE) global and subscores in classifying cognitive impairment in
persons with mild stroke and to explore the relationship between admission and
discharge functional status and improvement. DESIGN: Retrospective analysis of
data. SETTING: Acute rehabilitation unit of a large urban university-affiliated
hospital. PARTICIPANTS: Inpatients with stroke (N=72; mean age, 70y; median time
poststroke, 8.5d) and mild neurologic (median National Institutes of Health
Stroke Scale score, 4) and cognitive deficits (median MMSE score, 25).
INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Admission cognitive status
was assessed by using the MMSE and MoCA. The motor subscale of the FIM instrument
(mFIM) and motor relative functional efficiency was used to assess discharge
functional status and improvement. RESULTS: The MoCA classified more persons as
cognitively impaired than the MMSE (89% vs 63%, respectively; using a cutoff
score of 27 on the MMSE and 26 on the MoCA). The MoCA also showed less of a
ceiling effect than the MMSE, higher internal reliability (Cronbach alpha=.78
compared with alpha=.60), and marginally stronger associations with discharge
functional status (r=.40; P<.001) than the MMSE (r=0.30; P<.05). The MoCA
visuoexecutive subscore was the strongest predictor of functional status (P=.01)
and improvement (P=.02) in global and subscores for both tests. CONCLUSIONS: The
MoCA may be an important cognitive screening tool for persons with stroke and
mild cognitive dysfunction on an acute rehabilitation unit. Lower visuoexecutive
subscores may assist in identifying persons at risk for decreased functional
gains in self-care and mobility (mFIM) during inpatient rehabilitation. The
findings justify further validation studies of the MoCA in persons with subacute
stroke.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS