Data from: Early MoCA predicts long-term cognitive and functional outcome and mortality after stroke

Objective: To examine whether the Montreal Cognitive Assessment (MoCA)
administered within 7 days after stroke predicts long-term cognitive
impairment, functional impairment, and mortality. Methods: MoCA was
administered to 274 patients from two prospective hospital-based cohort
studies in Germany (n=125) and France (n=149). Cognitive and functional
outcomes were assessed at 6, 12 and 36 months post-stroke by comprehensive
neuropsychological testing, the Clinical Dementia Rating (CDR) scale,
modified Rankin Scale (mRS), and Instrumental Activities of Daily Living
(IADL), and analyzed using generalized estimating equations. All-cause
mortality was investigated by Cox proportional hazard models. Analyses
were adjusted for demographic variables, education, vascular risk factors,
premorbid cognitive status, and NIH Stroke Scale scores. The additive
predictive value of MoCA was examined using receiver operating
characteristic curves. Results: In pooled analyses a baseline MoCA
<26 was associated with cognitive impairment, defined by
neuropsychological testing (OR: 5.30, 95%CI: 2.75-10.22) and by CDR ≥0.5
(OR: 2.53, 95%CI: 1.53-4.18), functional impairment, defined by mRS
>2 (OR: 5.03, 95%CI: 2.20-11.51) and by IADL <8 (OR: 2.48,
95%CI: 1.40-4.38), and mortality (HR: 7.24, 95%CI: 1.99-26.35) across the
3-year follow-up. Patients with MoCA <26 performed worse across all
prespecified cognitive domains (executive function/attention, memory,
language, visuospatial ability). MoCA increased the area under the curve
for predicting cognitive impairment (neuropsychological testing; 0.81 vs.
0.72, p=0.01) and functional impairment (mRS >2; 0.88 vs. 0.84,
p=0.047). Conclusion: Early cognitive testing by MoCA predicts long-term
cognitive outcome, functional outcome and mortality after stroke. Our
results support routine use of the MoCA in stroke patients.