All patients underwent an assessment of demographic and clinical parameters, including the Cumulative Illness Rating Scale (CIRS) for the evaluation of pre-existing comorbidities, the National Institutes of Health Stroke Scale (NIHSS) for the evaluation of stroke severity, and the modified Rankin Scale (mRS]) at the time of admission and discharge from the stroke unit to evaluate global functioning before and after the acute event. In comparison with the original MOCA test, MOCA-B is a more culturally neutral test and does not include the CDT as the original version its subtests might be less influenced by language and grapho-motor impact.Ĭonsecutive patients with acute ischemic or hemorrhagic stroke admitted to the stroke unit of the Luigi Sacco University Hospital were recruited between January 1, 2018, and February 28, 2019. The two test were administered during the acute phase of stroke with the aim of assessing their predictivity on the occurrence of cognitive decline at follow-up in previously non-demented adults. For this reason, we wanted to extend the results of the study of Champod by comparing the performances of CDT with those of Montreal Cognitive Assessment Basic (MoCA-B). suggested the use of clock drawing test (CDT) in the acute phase due to its predictivity of functional and cognitive outcomes one year after stroke the authors further advised to administer CDT in association with another screening test to compare predictive abilities. Handy cognitive instruments to systematically assess stroke patients at bedside would be useful to formulate a cognitive prognosis, but there is no consensus about the best tools to use. In some cases, PSCI severity can worsen over time, perhaps because of an underlying degenerative or micro-vascular pathology.Įarly identification of patients at risk for PSCI is likely important for the assessment of subacute and long-term management strategies for stroke patients (e.g., rehabilitation, adherence to therapies and to risk factors control). PSCI is a clinical entity that encompasses all types of cognitive decline following an index stroke it may occur immediately or in the first months after stroke. In two-thirds of cases, PSCI corresponds to a mild cognitive impairment, in one third to dementia and significantly impacts the quality of life of stroke survivors. In collective perception as well as in clinical trials, disability after stroke is mainly intended as physical disability, although a broader vision that includes evaluation of cognitive impairment is recommended because more than half of stroke survivors experience post-stroke cognitive impairment (PSCI). The major burden of stroke concerns the chronic phase. Stroke is the second leading cause of death and the third leading cause of disability worldwide. ConclusionĪ bedside cognitive screening with the CDT helps identifying patients at higher risk of PSCI. A pathological baseline score on MoCA-B (< 24) did not predict increased risk of cognitive decline at follow-up nor increased predictivity of stand-alone CDT. In multi-adjusted (for age, education, comorbidities score, NIHSS at admission and atrophy score) model, a pathological score on baseline CDT (< 6.55) was associated with a higher risk of PSCI at follow-up (HR 2.022 95% CI 1.025–3.989, p < 0.05) with respect to non-pathological scores. In comparison with patients who remained cognitively stable at follow-up, these patients were older, less educated, had more comorbidities, a higher score on the National Institutes of Health Stroke Scale (NIHSS) at admission, more severe cerebral atrophy, and lower MoCA-B and CDT scores at baseline. At follow-up (mean duration ± SD 12.8 ± 8.7 months), 28 (18.9%) incident cases of MCI and 27 (18%) cases of dementia were recorded. Out of 191 stroke survivors who were non-demented at baseline, 168 attended at least one follow-up visit. MethodsĪ cognitive assessment within a few days of ischemic or hemorrhagic stroke was performed in patients consecutively admitted to a stroke unit over 14 months by means of the Clock Drawing Test (CDT) and the Montreal Cognitive Assessment-Basic (MoCA-B). We aimed to determine the predictivity of two screening cognitive tests on the occurrence of mild cognitive impairment or dementia in acute stroke patients. The early detection of patients at risk of post-stroke cognitive impairment (PSCI) may help planning subacute and long-term care.
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