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      Evaluation of the Mini-Mental State Examination and the Montreal Cognitive Assessment for Predicting Post-stroke Cognitive Impairment During the Acute Phase in Chinese Minor Stroke Patients

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          Abstract

          Objective: To assess the value of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) during acute phase in predicting post-stroke cognitive impairment (PSCI) at 3–6 months.

          Methods: We prospectively recruited 229 patients who had suffered their first-ever ischemic stroke. PSCI was determined in 104 of these patients by a comprehensive neuropsychological battery performed at 3–6 months. Receiver operating characteristic (ROC) curve analysis was then performed to compare the discriminatory ability of the MMSE and MoCA. Also, we applied a decision tree generated by the classification and regression tree methodology.

          Results: In total, 66 patients had PSCI when evaluated 3–6 months after the onset of minor stroke. Logistic regression analysis revealed that education, body mass index (BMI), and baseline MoCA scores were independently associated with PSCI. ROC curve analysis showed that the ability to predict PSCI was similar when compared between baseline MoCA scores [area under curve (AUC), 0.821; 95% confidence interval (CI), 0.743–0.898] and baseline MMSE scores (AUC, 0.809; 95% CI, 0.725–0.892, P = 0.75). Both MMSE and MoCA exhibited similar predictive values at their optimal cut-off points (MMSE ≤27; sensitivity, 0.682; specificity, 0.816; MoCA ≤21; sensitivity, 0.636; specificity, 0.895). Classification and regression tree-derived analysis yielded an AUC of 0.823 (sensitivity, 0.803; specificity, 0.842).

          Conclusion: When applied within 2 weeks of stroke, the MMSE and MoCA are both useful and have similar predictive value for PSCI 3–6 months after the onset of minor stroke.

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          Most cited references20

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          The Informant Questionnaire on cognitive decline in the elderly (IQCODE): a review.

          The IQCODE is widely used as a screening test for dementia, particularly where the subject is unable to undergo direct cognitive testing or for screening in populations with low levels of education and literacy. This review draws together research on the psychometric properties and validity of the IQCODE. A systematic search of the literature was carried out using three databases. The review shows that the questionnaire has high reliability and measures a single general factor of cognitive decline. It validly reflects past cognitive decline, performs at least as well at screening as conventional cognitive screening tests, predicts incident dementia, and correlates with a wide range of cognitive tests. A particular strength is that the IQCODE is relatively unaffected by education and pre-morbid ability or by proficiency in the culture's dominant language. The disadvantage of the IQCODE is that it is affected by informant characteristics such as depression and anxiety in the informant and the quality of the relationship between the informant and the subject. Because the IQCODE provides information complementary to brief cognitive tests, harnessing them together can improve screening accuracy.
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            Clock drawing in Alzheimer's disease. A novel measure of dementia severity.

            We have tested a simple and reliable measure of visuospatial ability in Alzheimer patients--the Clock Drawing Test. To determine the usefulness of this measure, we asked 67 Alzheimer patients and 83 normal controls to draw the face of a clock reading the time of 2:45. Six independent observers blindly evaluated the results with ratings from 10 (best) to 1 (worst). The mean performance score of Alzheimer subjects was 4.9 +/- 2.7 compared to 8.7 +/- 1.1 for normal controls (P less than .001). Inter-rater reliability for the clocks drawn by Alzheimer patients was highly significant (r = 0.86; P less than .001), and there was relatively little overlap between ratings for Alzheimer patients and normal controls. Furthermore, correlations were highly significant (P less than .001) between the mean score of clock drawings and three independent global measures of dementia severity. Although the Clock Drawing Test is certainly not a definitive indicator of Alzheimer's disease, the test is easy to administer and provides a useful measure of dementia severity for both research and office settings where sophisticated neuropsychological testing is not available.
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              Post-stroke cognitive impairment is common even after successful clinical recovery.

              Cognitive impairment is common after stroke, but the prevalence and long-term significance of the diverse neuropsychological deficits on functional outcome are still not well known. The frequency and prognostic value of domain-specific cognitive impairments were investigated in a large cohort of ischaemic stroke patients.
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                Author and article information

                Contributors
                Journal
                Front Aging Neurosci
                Front Aging Neurosci
                Front. Aging Neurosci.
                Frontiers in Aging Neuroscience
                Frontiers Media S.A.
                1663-4365
                06 August 2020
                2020
                : 12
                : 236
                Affiliations
                [1] 1Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou, China
                [2] 2Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
                [3] 3Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine , Hangzhou, China
                Author notes

                Edited by: Alessandro Martorana, University of Rome Tor Vergata, Italy

                Reviewed by: Fabrizio Sallustio, University of Rome Tor Vergata, Italy; Nilo Riva, San Raffaele Hospital (IRCCS), Italy

                *Correspondence: Yanxing Chen chenyanxing@ 123456zju.edu.cn Baorong Zhang brzhang@ 123456zju.edu.cn
                Article
                10.3389/fnagi.2020.00236
                7424073
                32848712
                f94571f0-58fb-4960-ba95-ac08987aeae0
                Copyright © 2020 Zhu, Zhao, Fan, Li, He, Lin, Topatana, Yan, Liu, Chen and Zhang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 17 April 2020
                : 08 July 2020
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 29, Pages: 7, Words: 4761
                Categories
                Neuroscience
                Original Research

                Neurosciences
                mini-mental state examination,montreal cognitive assessment,prediction,cognitive impairment,acute stroke

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