Department of Neurology, University Hospital, Inselspital, University of Bern, Freiburgstr. 16, 3010, Bern, Switzerland.
Graduate School of Health Sciences, University of Bern, Bern, Switzerland.
Sci Rep. 2024 Aug 29;14(1):20125. doi: 10.1038/s41598-024-71184-x.
Given advantages in reperfusion therapy leading to mild stroke, less apparent cognitive deficits can be overseen in a routine neurological examination. Despite the widespread use of the Montreal Cognitive Assessment (MoCA), age- and education-specific cutoffs for the detection of post-stroke cognitive impairment (PSCI) are not established, hampering its valid application in stroke. We aimed to establish age- and education-specific MoCA cutoffs to better discriminate patients with and without acute PSCI. Patients with acute ischemic stroke underwent the MoCA and a detailed neuropsychological assessment. PSCI was defined as a performance < - 1.5 SD in ≥ 2 cognitive domains. As secondary data analysis, the discriminant abilities of the MoCA-score (not adding + 1 as correction for ≤ 12 years of education, YoE) cutoffs were automatically derived based on Youden Index and evaluated by receiver operating characteristic analyses across age- (< 55, 55-70, > 70 years old) and education-specific (≤ 12 and > 12 YoE) groups. 351 stroke patients (67.4 ± 14.1 years old; 13.1 ± 2.8 YoE) underwent the neuropsychological assessment 2.7 ± 2.0 days post-stroke. The original MoCA cutoff < 26 falsely classified 26.2% of examined patients, with poor sensitivity in younger adults (34.8% in patients < 55 years > 12 YoE) and poor specificity in older adults (55.0%, in > 70 years ≤ 12 YoE). By maximizing both sensitivity and specificity, the optimal MoCA cutoffs were: (i) < 28 in patients aged < 55 with > 12 YoE (sensitivity = 69.6%, specificity = 77.8%); (ii) < 22 and < 25 in patients > 70 years with ≤ 12 and > 12 YoE (sensitivity = 61.6%, specificity = 90.0%; sensitivity = 63.3%, specificity = 84.0%, respectively). In other groups the optimal MoCA cutoff was < 26. Age and education level should be considered when interpreting MoCA-scores. Though new age- and education-specific cutoffs demonstrated higher discriminant ability for PSCI, their performance in young stroke and adults with higher education level was low due to ceiling effects and MoCA subtests structure, and cautious interpretation in these patients is warranted.Trial registration: ClinicalTrials.gov Identifier: NCT05653141.
鉴于再灌注治疗在轻度中风中的优势，在常规神经系统检查中可能会忽略不太明显的认知缺陷。尽管蒙特利尔认知评估（MoCA）应用广泛，但针对中风后认知障碍（PSCI）的年龄和教育特定截断值尚未确定，这阻碍了其在中风中的有效应用。我们旨在建立年龄和教育特定的 MoCA 截断值，以更好地区分急性 PSCI 患者和非 PSCI 患者。急性缺血性中风患者接受了 MoCA 和详细的神经心理学评估。PSCI 定义为在至少 2 个认知领域的表现 < -1.5 SD。作为二次数据分析，根据约登指数自动推导了 MoCA 评分（不添加 + 1 作为对 ≤ 12 年教育的校正，YoE）截断值的判别能力，并通过在年龄（< 55、55-70、> 70 岁）和教育特定（≤ 12 和 > 12 YoE）组内进行的接收者操作特征分析进行评估。351 名中风患者（67.4±14.1 岁；13.1±2.8 YoE）在中风后 2.7±2.0 天接受了神经心理学评估。原始 MoCA 截断值 < 26 错误地分类了 26.2%的检查患者，在年轻成年人中的敏感性较差（34.8%在患者 < 55 岁 > 12 YoE），在老年成年人中的特异性较差（55.0%，在 > 70 岁 ≤ 12 YoE）。通过最大限度地提高敏感性和特异性，最佳的 MoCA 截断值为：（i）在 > 12 YoE 的< 55 岁患者中 < 28（敏感性 = 69.6%，特异性 = 77.8%）；（ii）在 ≤ 12 和 > 12 YoE 的 > 70 岁患者中 < 22 和 < 25（敏感性 = 61.6%，特异性 = 90.0%；敏感性 = 63.3%，特异性 = 84.0%）。在其他组中，最佳 MoCA 截断值为 < 26。解释 MoCA 评分时应考虑年龄和教育水平。尽管新的年龄和教育特定截断值对 PSCI 具有更高的判别能力，但由于天花板效应和 MoCA 子测试结构，年轻中风患者和接受高等教育的成年人的表现较差，因此在这些患者中需要谨慎解释。
试验注册：ClinicalTrials.gov 标识符：NCT05653141。
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