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Research paper
Brief screening tests during acute admission in patients with mild stroke are predictive of vascular cognitive impairment 3–6 months after stroke
  1. YanHong Dong1,2,
  2. Narayanaswamy Venketasubramanian3,
  3. Bernard Poon-Lap Chan3,
  4. Vijay Kumar Sharma3,
  5. Melissa Jane Slavin2,
  6. Simon Lowes Collinson4,
  7. Perminder Sachdev2,
  8. Yiong Huak Chan5,
  9. Christopher Li-Hsian Chen1
  1. 1Department of Pharmacology, National University Health System, Singapore
  2. 2School of Psychiatry, University of New South Wales, New South Wales, Australia
  3. 3Department of Medicine, National University Health System, Singapore
  4. 4Department of Psychology, National University of Singapore, Singapore
  5. 5Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
  1. Correspondence to Dr Professor Christopher Li-Hsian Chen, Department of Pharmacology, National University Health System, Clinical Research Centre, MD11, Level 5, #05-9, 10 Medical Drive, Singapore 117597; phccclh{at}


Objectives To determine the prognostic value of brief cognitive screening tests administered in the subacute stroke phase (initial 2 weeks) for the detection of significant cognitive impairment 3–6 months after stroke, the authors compared the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE).

Methods Patients with ischaemic stroke and transient ischaemic attack were assessed with both MoCA and MMSE within 14 days after index stroke, followed by a formal neuropsychological evaluation of seven cognitive domains 3–6 months later. Cognitive outcomes were dichotomised as either no–mild (impairment in ≤2 cognitive domains) or moderate–severe (impairment in ≥3 cognitive domains) vascular cognitive impairment. Area under the receiver operating characteristic (ROC) curve analysis was used to compare discriminatory ability.

Results 300 patients were recruited, of whom 239 received formal neuropsychological assessment 3–6 months after the stroke. 60 (25%) patients had moderate–severe VCI. The overall discriminant validity for detection of moderate–severe cognitive impairment was similar for MoCA (ROC 0.85 (95% CI 0.79 to 0.90) and MMSE (ROC 0.83 (95% CI 0.77 to 0.89)), p=0.96). Both MoCA (21/22) and MMSE (25/26) had similar discriminant indices at their optimal cutoff points; sensitivity 0.88 versus 0.88; specificity 0.64 versus 0.67; 70% versus 72% correctly classified. Moreover, both tests had similar discriminant indices in detecting impaired cognitive domains.

Conclusions Brief screening tests during acute admission in patients with mild stroke are predictive of significant vascular cognitive impairment 3–6 months after stroke.

  • Vascular dementia
  • acute stroke
  • predictive value of tests
  • cerebrovascular disease
  • cognitive neuropsychology
  • dementia
  • stroke
  • cognition
  • Alzheimer s disease
  • neuropsychology

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  • Funding This study is funded by a Center Grant from the National Medical Research Council (NMRC/CG/NUHS/2010). YHD has received research support by a NMRC fellowship training award.

  • Competing interests None declared.

  • Ethics approval The ethics approval was provided by the local ethics committee of National Healthcare Group Domain Specific Review Board A.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement YHD has full access to all of the data and has the right to publish any and all data separate and apart from any sponsor. There are no additional unpublished data to others.