Using the Montreal Cognitive Assessment (MoCA): to Predict Three Month Recovery Following a Stroke

Congratulations to Parunyou JulayanontKulrithra PisanuwongrakKenneth Heilman on the publication of “Using the Montreal Cognitive Assessment (MoCA): to Predict Three Month Recovery Following a Stroke,” in the April 9th edition of Neurology.


Objective: 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.

Background: 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.

Design/Methods: 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.

Results: 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.

Conclusions: 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.