SCREENING FOR COGNITIVE IMPAIRMENT WITH THE MOCA IN YOUNG MINOR STROKE PATIENTS: FINDINGS FROM A PROSPECTIVE OBSERVATIONAL STUDY

Background and aims: About half of all stroke patients under the age
of 50 have cognitive deficits. If these are subtle, they may escape routine
neurological examination. The aim of this study was to investigate
whether the Montreal Cognitive Assessment (MoCA), an internationally
recommended screening tool for cognitive assessment in stroke patients,
is suitable for detecting cognitive deficits in younger stroke patients with
a minor stroke.
Methods: Patients aged 18 to 55 years with a minor (NIHSS ⩽5)
ischemic stroke were eligible for inclusion in this prospective observational
study. The primary endpoint was to assess the sensitivity of the
MoCA. Secondary endpoints were specificity, positive and negative predictive
value. A comprehensive neuropsychological assessment (CNA)
and the MoCA were completed at least 3 days after stroke. The CNA
assessed memory, attention, language, visuospatial and executive functions
with multiple tasks for each domain.
Results: Of 121 patients who met the inclusion criteria between April
2021 and December 2023, 34 were enrolled. Median age was 48 years
(41; 52) and 35% were female. The median interval between stroke and
screening was 5 days (4; 7). Half of the patients scored 1.5 standard deviations
below the population norm in at least one cognitive domain. The
MoCA detected this impairment in only four cases (cut-off <26), giving a
sensitivity of 24%. The specificity, positive predictive value and negative
predictive value were 88%, 66% and 54% respectively.
Conclusions: Our data suggest that the MoCA is not sensitive to cognitive
impairment in young minor stroke patients.