Application Value Of MMSE And MoCA In The Acute Phase Predicting Post-Stroke Cognitive Impairment

ObjectivePost-stroke cognitive impairment(PSCI)is a common sequel after stroke and is related to poor functional outcomes even poor survival.The main purpose of our study is to assess the value of Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)which are evaluated in the acute phase in predicting PSCI at 3-6 monthsMethods229 patients with acute first-ever ischemic stroke were prospectively recruited between February 2018 and March 2019 from Department of Neurology,The Second Affiliated Hospital,Zhejiang University School of Medicine.All patients were assessed with both MMSE and MoCA within 2 weeks after stroke.PSCI was determined by a comprehensive neuropsychological battery performed at 3-6 months in 104 patients Receiver operating characteristic(ROC)curve analysis was performed to compare the discriminatory ability of MMSE and MoCA in predicting PSCI at 3-6 months and determine their optimal cut-offs.Decision tree analysis was used to further determine risk factors of PSCIResults66 patients(63.5%)had PSCI at 3-6 months.PSCI was associated with education,body mass index(BMI),MMSE scores in the acute phase,and MoCA scores in the acute phase.Logistic regression analysis revealed that education,BMI,and MoCA scores in the acute phase were independently associated with PSCI(P<0.05).ROC curve analysis showed that the predictive validity for PSCI was similar between MMSE scores in the acute phase((AUC,0.809;95%CI 0.725 to 0.892)and MoCA scores in the acute phase(AUC,0.821;95%CI,0.743 to 0.898),P=0.75).Both MMSE and MoCA had similar predictive value at their optimal cutoff points(MMSE<27;sensitivity,68.2%;specificity,81.6%;MoCA<21;sensitivity,63.6%;specificity,89.5%)ConclusionThe application of MMSE and MoCA in the acute phase after stroke are both of great value to predict PSCI at 3-6 months.The optimal cut-offs of MMSE and MoCA are 27 and 21,respectively.