To evaluate the usefulness of Montreal Cognitive Assessment (MoCA) to predict 3-month functional recovery in post-ischemic stroke patients with moderate to severe functional impairment on admission.

Whereas a relationship in stroke patients between their cognitive impairment and functional outcome has been studied, there has been no reports of differences based on their pre-stroke cognitive abilities and education, as well as the utility of MoCA to predict the functional improvement in stroke patients.  

119 subjects with acute ischemic stroke aged >18 years were recruited from the tertiary neurological center in Thailand. The MoCA and the modified Rankin Scale (mRS) were tested on admission and at 3-month post-stroke. Patients with pre-existing dementia and depression were excluded. Only patients with mRS 3-5 (moderately to severely impaired) on admission were analyzed. Receiver Operating Characteristic (ROC) curves were analyzed to evaluate the usefulness of the MoCA in identifying patients who improved at three-months post-stroke from mRS 3-5 to mRS 0-2.

57 subjects had mRS of 3-5 on admission.  45/57 (79%) subjects at three months improved to independency (mRS 0-2) and 12/57 (21%) continued to be functionally dependent (mRS 3-5). Average independency and dependency groups baseline MoCA were 16.31 (SD 5.89), and 9.00 (SD 4.66) respectively (t=3.98, p<0.001). Mean ages were 64.29 (SD 10.83) and 72.75 (SD 9.05) respectively (t=-2.48, p=0.02). The ROC curve showed that MoCA predicted functional improvement (ROC values=0.83, p=0.001). 92% of the subjects with the MoCA cut-off ≥12 improved to functional independency at 3 month (sensitivity 78%, specificity 75%). There were no significant differences in gender, education, comorbidities and stroke characteristics.

The MoCA score of ≥12 on admission predicts improvement from functional dependency to independency at 3 months post-stroke. Using the MoCA clinicians can better predict the functional recovery of patients with an ischemic stroke.