Use of Montreal Cognitive Assessment in patients with stroke.

M ore than 40% of stroke survivors are found with cog-nitive impairment (poststroke cognitive impairment [PSCI]) sometime after the event. 1 Almost two thirds of these patients are affected by mild cognitive impairment (MCI). 2 A meta-analysis showed that 10% of patients had dementia before first stroke, 10% developed dementia soon after first stroke, and more than a third had dementia after recurrent stroke. 3 Ideally, cognitive evaluation of patients with stroke should start early after the event, but this may be difficult. In fact, a cognitive evaluation is not a part of the routine assessment of patients with acute stroke in most centers, and items assessing cognitive functions are poorly represented in the most widely used acute stroke scales. The Montreal Cognitive Assessment (MoCA) is a brief screening instrument originally designed to identify MCI in elderly patients attending a memory clinic. 4 MoCA is a 1-page, 30-point test, administrable in ≈10 minutes, which evaluates different domains: visuospatial abilities, executive functions, short-term memory recall, attention, concentration , working memory, language, and orientation to time and space (Figure). 5 A shortened version of MoCA has been proposed as a first assessment of patients with vascular cognitive impairment by a consensus conference. 6 When compared with another widely used cognitive screening test, the Mini Mental State Examination (MMSE), one of the possible strengths of MoCA in the vascular patient setting is the assessment of executive functions and the presence of more demanding visual construction tasks. 7 The consensus conference proposal was generally directed to not otherwise specified vascular cognitive impairment patients 6 ; however, MoCA has recently been used by various groups in the research stroke setting (online-only Data Supplement). However, the use of MoCA in usual stroke practice is not frequent. 8 In this article, we reviewed the literature on the use of MoCA in patients with stroke. We dealt separately with articles in which the test was administrated in the acute/subacute (the first 4 weeks after stroke) or in the chronic phase after stroke (any time after the first 4 weeks). The aim of this review is to spotlight the diffusion, the main results, the indications, and limitations of the use of MoCA in the stroke setting. This work could serve to implement the use of MoCA in the stroke setting and establish a first level of knowledge about the advantages and limitations of this test. Suggestions and research lines …