School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Limburg Brain Injury Centre, Maastricht University, Maastricht, The Netherlands.
Brain Inj. 2024 Jul 28;38(9):687-691. doi: 10.1080/02699052.2024.2341039. Epub 2024 Apr 14.
Detecting cognitive impairments early after stroke is essential for appropriate referrals. Although recommended in stroke guidelines, early cognitive screening is not always implemented. We assessed whether the Montreal Cognitive Assessment (MoCA) adds diagnostic value compared to clinical observation alone. In addition, discharge destinations for stroke patients with and without cognitive deficits detected with the screening tool or the treatment team were explored.
Forty-four stroke patients were screened with the MoCA during stroke unit admission. Their charts were studied for cognitive impairments reported by the stroke care team, who were blinded to screening scores. Proportions of detected cognitive deficits were compared between screening (score <26) and patient charts. Discharge destination distribution (home vs. rehabilitation) was explored.
The proportion of cognitively impaired patients indicated by the MoCA (84%) and reported in patients' charts (25%) differed significantly ( < 0.001). The distribution of discharge destination did not suggest an association with the detection of cognitive deficits by the treatment team or the cognitive screening.
The MoCA detects more cognitive deficits than clinical impression alone, emphasizing the importance of standard screening for cognitive impairments in acute stroke patients. Ultimately, systematic screening may enhance discharge planning and improve long-term outcomes.
早期发现脑卒中后的认知障碍对于适当的转介至关重要。尽管脑卒中指南中推荐进行早期认知筛查，但实际上并未始终实施。我们评估了蒙特利尔认知评估（MoCA）与仅基于临床观察相比是否具有额外的诊断价值。此外，我们还探讨了使用筛查工具或治疗团队发现存在认知缺陷的脑卒中患者与不存在认知缺陷的患者的出院去向。
44 名脑卒中患者在脑卒中单元入院期间接受了 MoCA 筛查。研究了他们的病历，以了解脑卒中护理团队报告的认知障碍，而团队对筛查评分并不知情。比较了筛查（得分<26）和患者病历中报告的认知缺陷的检出比例。探索了出院去向分布（家庭与康复）。
MoCA 提示的认知障碍患者比例（84%）与患者病历中报告的认知障碍患者比例（25%）存在显著差异（ < 0.001）。治疗团队或认知筛查发现认知缺陷的分布与出院去向之间没有明显关联。
MoCA 比单纯的临床印象能更准确地发现认知障碍，强调了对急性脑卒中患者进行认知障碍常规筛查的重要性。最终，系统的筛查可能会改善出院计划并改善长期预后。
