Background/Aims: Even mild stroke survivors may sometimes experience residual cognitive damage. No consensus has emerged about which cognitive test is most appropriate for the diagnosis of poststroke cognitive impairment. We aim to compare a computerized battery of neuropsychological tests for memory, attention and executive functions (MindStreams®) with the Montreal Cognitive Assessment (MoCA) to detect mild-to-moderate cognitive impairments in poststroke patients. Methods: Subjects enrolled to the TABASCO (Tel Aviv Brain Acute Stroke Cohort) study, a prospective study which includes consecutive first-ever mild-to-moderate stroke patients, were included. All participants underwent neurological and cognitive evaluations. Results: A total of 454 patients with transient ischemic attack (TIA) or stroke are reported. Their mean MoCA and MindStreams scores were lower than normal; however, the TIA group presented significantly better scores using either method. The correlation between the MoCA and the computerized global score was 0.6 (p < 0.001). A significant correlation was found between the subcategory scores (executive function, memory and attention). However, the MoCA identified many more subjects with low scores (<26) compared to the MindStreams (70.6 vs. 15.7%). Conclusion: Our results demonstrate that either of the modalities alone is sensitive enough for identifying subtle cognitive impairment and none picks up substantially more cognitive losses than the other in patients with cerebrovascular disease.

Keywords:
Stroke, Cognitive impairment, Montreal Cognitive Assessment, MindStreams, Computerized cognitive assessment battery
1.
Linden T, Skoog I, Fagerberg B, Steen B, Blomstrand C: Cognitive impairment and dementia 20 months after stroke. Neuroepidemiology 2004;23:45-52.
2.
Pasquini M, Leys D, Rousseaux M, Pasquier F, Henon H: Influence of cognitive impairment on the institutionalisation rate 3 years after a stroke. J Neurol Neurosurg Psychiatry 2007;78:56-59.
3.
Pendlebury ST, Rothwell PM: Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol 2009;8:1006-1018.
4.
Bejot Y, Aboa-Eboule C, Durier J, Rouaud O, Jacquin A, Ponavoy E, et al: Prevalence of early dementia after first-ever stroke: a 24-year population-based study. Stroke 2011;42:607-612.
5.
Korczyn AD: The complex nosological concept of vascular dementia. J Neurol Sci 2002;203-204:3-6.
6.
Nussbaum M, Treves TA, Korczyn AD: DSM-III-R criteria for primary degenerative dementia and multi-infarct dementia (corrected). Alzheimer Dis Assoc Disord 1992;6:111-118.
7.
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41.
8.
Ben Assayag E, Korczyn AD, Giladi N, Goldbourt U, Berliner AS, Shenhar-Tsarfaty S, et al: Predictors for poststroke outcomes: the Tel Aviv Brain Acute Stroke Cohort (TABASCO) study protocol. Int J Stroke 2012;7:341-347.
9.
Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al: The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695-699.
10.
Korczyn AD, Vakhapova V, Grinberg LT: Vascular dementia. J Neurol Sci 2012;322:2-10
11.
Doniger GM, Jo MY, Simon ES, Crystal HA: Computerized cognitive assessment of mild cognitive impairment in urban African Americans. Am J Alzheimers Dis Other Demen 2009;24:396-403.
12.
Popovic IM, Lovrencic-Huzjan A, Simundic AM, Popovic A, Seric V, Demarin V: Cognitive performance in asymptomatic patients with advanced carotid disease. Cogn Behav Neurol 2011;24:145-151.
13.
Ihara M, Okamoto Y, Takahashi R: Suitability of the Montreal Cognitive Assessment versus the Mini-Mental State Examination in detecting vascular cognitive impairment. J Stroke Cerebrovasc Dis, E-pub ahead of print.
14.
Freitas S, Simoes MR, Alves L, Vicente M, Santana I: Montreal Cognitive Assessment (MoCA): validation study for vascular dementia. J Int Neuropsychol Soc 2012;18:1031-1040.
15.
Damian AM, Jacobson SA, Hentz JG, Belden CM, Shill HA, Sabbagh MN, et al: The Montreal Cognitive Assessment and the Mini-Mental State Examination as screening instruments for cognitive impairment: item analyses and threshold scores. Dement Geriatr Cogn Disord 2011;31:126-131.
16.
Wong A, Xiong YY, Kwan PW, Chan AY, Lam WW, Wang K, et al: The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dement Geriatr Cogn Disord 2009;28:81-87.
17.
Dalrymple-Alford JC, MacAskill MR, Nakas CT, Livingston L, Graham C, Crucian GP, et al: The MoCA: well-suited screen for cognitive impairment in Parkinson disease. Neurology 2010;75:1717-1725.
18.
Costa AS, Fimm B, Friesen P, Soundjock H, Rottschy C, Gross T, et al: Alternate-form reliability of the Montreal Cognitive Assessment screening test in a clinical setting. Dement Geriatr Cogn Disord 2012;33:379-384.
19.
Dwolatzky T, Whitehead V, Doniger GM, Simon ES, Schweiger A, Jaffe D, et al: Validity of a novel computerized cognitive battery for mild cognitive impairment. BMC Geriatr 2003;3:4.
20.
Dong Y, Sharma VK, Chan BP, Venketasubramanian N, Teoh HL, Seet RC, et al: The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci 2010;299:15-18.
21.
Dwolatzky T, Whitehead V, Doniger GM, Simon ES, Schweiger A, Jaffe D, et al: Validity of the MindStreams computerized cognitive battery for mild cognitive impairment. J Mol Neurosci 2004;24:33-44.
22.
Doniger GM, Dwolatzky T, Zucker DM, Chertkow H, Crystal H, Schweiger A, et al: Computerized cognitive testing battery identifies mild cognitive impairment and mild dementia even in the presence of depressive symptoms. Am J Alzheimers Dis Other Demen 2006;21:28-36.
23.
Doniger GM, Zucker DM, Schweiger A, Dwolatzky T, Chertkow H, Crystal H, et al: Towards practical cognitive assessment for detection of early dementia: a 30-min computerized battery discriminates as well as longer testing. Curr Alzheimer Res 2005;2:117-124.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.