Screening and Assessment of Vascular Cognitive Impairment

Vascular Cognitive
Impairment and Dementia:
Screening and Assessment
Canadian Best Practice Recommendations for Stroke Care 2012-2013 Update

Update March 2013

Vascular Cognitive Impairment and Dementia Review 2012 - 2013

Table of Contents

1) Vascular Cognitive Impairment and Dementia Evidence Tables .............................................................................................................................. 2

a) What is the prevalence of Cognitive Impairment after stroke? ........................................................................................................................... 2
b) What is the impact of Neuropsychological/Neurocognitive deficits on stroke outcome?................................................................................. 12
c) What tools are used to assess VCI? .................................................................................................................................................................... 20
d) Imaging ............................................................................................................................................................................................................... 21
e) Cognitive tests .................................................................................................................................................................................................... 25
f) What are the differences between the tools used to assess VCI? (ie. Sensitivity, efficacy, etc)......................................................................... 33
2) Assessment Tools ................................................................................................................................................................................................... 37
References .................................................................................................................................................................................................................. 47

Last Updated March, 2013 Page 1 of 51


Evidence Summary
1) Vascular Cognitive Impairment and Dementia Evidence Tables

a) What is the prevalence of Cognitive Impairment after stroke?

Study Country Study Type Population Outcomes Follo Assessment tests Prevalence of outcomes
w up used/ discussed
Bejot, 2011 France Observational 3201 first stroke Prevalence of 24 The diagnosis of Patients with poststroke dementia
patients dementia (653 years poststroke dementia differed from those without
Prevalence of (20.4%) had was based on a poststroke dementia. They were
early dementia simple standardized older (77.3+10.8 years versus
poststroke
after first-ever clinical approach 71.7+15.4 years, P<0.0001);
stroke: a 24-year
dementia (337 using Diagnostic and had a higher prevalence of several
population-based women and 316 Statistical Manual of vascular risk factors, including
study men).) Mental Disorders, hypertension, diabetes, atrial
Third and Fourth fibrillation, previous myocardial
Editions infarction, and history of transient
ischemic attack; and were more
likely to have received stroke
preventive medications, including
antiplatelet agents and
antihypertensive treatment. In
addition, they were more likely to
have hemiplegia at admission, and
there was a higher prevalence of
lacunar stroke but a lower
prevalence of intracerebral
hemorrhage, subarachnoid
hemorrhage, and nonlacunar
noncardioembolic ischemic
strokes in these patients.


Racic, 2011 Bosnia and Observational 273 stroke patients Vascular dementia 3 National Institute of Forty-‐nine (19.52%) patients met
poststroke months Health National the criteria for vascular dementia.
Herzegovin
Vascular Institute of The demented patients had a
dementia: clinical
a Neurological statistically significant presence of
and Disorders and Stroke both atrial fibrillation and
neuroradiological (NIH-‐NINDS), score ventricular arrhythmias (p<0.01)
correlation Mini Mental State and previous stroke (p <0.05)
Examination Score compared with the non-‐demented
(MMSE), and patients. A statistically significant
Hachinski Ischemic difference was demonstrated in
Score (HIS) the presence of bilateral lesions in
the demented patients (p<0.01).

Wadley, 2011 USA Observational 23, 913 participants Impaired cognitive Mean= Six-‐Intern Screen A total of 1,937 participants
with no previous screening status 4.1 (SIS), fluency and (8.1%) declined to an SIS score <4
Incident cognitive years recall tasks at their most recent assessment,
stroke or dementia +1.6
impairment is over a mean of 4.1 (61.6) years.
elevated in the Residents of the Southern Stroke
stroke belt: the Belt in the USA had greater
REGARDS study. adjusted odds of incident
cognitive impairment than non-‐
Belt residents (odds ratio, 1.18;
95% confidence interval, 1.07–
1.30). All demographic factors and
time independently predicted
impairment.
Wolfe, 2011 UK Observational 3373 first stroke Disability (Barthel Up to Disability (Barthel The highest rate of disability was
patients Index <15), ten Index <15), inactivity observed 7 d after stroke and
Estimates of inactivity years (Frenchay Activities remained at around 110 per 1,000
outcomes up to (Frenchay Index <15), cognitive stroke survivors from 3 mo to 10
ten years after Activities Index impairment y. Rates of inactivity and cognitive
stroke: analysis <15), cognitive (Abbreviated Mental impairment both declined up to 1
from the impairment Test <8 or Mini-‐ y (280/1,000 and 180/1,000
prospective south (Abbreviated Mental State Exam survivors, respectively). Increased
London stroke Mental Test <8 or <24), anxiety and age was associated with higher
register Mini-‐Mental State depression (Hospital rates of disability, inactivity, and
Exam <24), anxiety Anxiety and cognitive impairment.
and depression Depression Scale


(Hospital Anxiety >10), and mental and

and Depression physical domain
Scale >10), and scores of the Medical
mental and Outcomes Study 12-‐
physical domain item short form (SF-‐
scores of the 12) health survey
Medical Outcomes
Study 12-‐item
short form (SF-‐12)
health survey
Delgado, 2010 Chile Observational 164 patients aged 1 Poststroke 12 the short Spanish Out of 122 patients (74%)
60 years admitted Cognitive months version of the evaluated at 3 months, 81 (66%)
Frequency and with an ischemic or impairment Informant had CI. Out of 101 patients (62%)
determinants of hemorrhagic stroke Questionnaire on evaluated at 12 months, 39 (39%)
poststroke was conducted. Cognitive Decline in had CI no dementia, and 22 (22%)
cognitive the Elderly (SS-‐ were demented. The new-‐onset
impairment at IQCODE), The dementia frequency at 1 year was
three and twelve functional 16%. Independent determinants
months in Chile impairment in for dementia were higher
activities of daily functional impairment at hospital
living (ADL) not egress (OR = 4.0), left hemisphere
related to motor large-‐vessel infarction (OR = 6.9)
disability was rated by and a larger amount of white
the Pfeffer functional matter changes (OR = 1.3).
assessment
questionnaire (PFAQ),
MMSE, Mattis
Dementia Rating
Scale total score, The
Frontal Assessment
Battery, 1-‐min
phonemic verbal
fluency with letters F,
A and S and 1-‐min
semantic fluency
tests, Yesavage
Geriatric Depression
Scale


Savva, 2010 UK Systematic population with Incident dementia NA NA A history of stroke doubles the
Review stroke compared risk of incident dementia in the
Epidemiological with the population older population. This increase is
studies of the without stroke not explained by demographic or
effect of stroke on cardiovascular risk factors or by
incident prestroke cognitive decline. The
dementia: a excess risk of incident dementia
systematic review diminishes with time after stroke
and may be higher in those
without an APOE Є4 allele. There
is no excess risk of incident
dementia in those aged >85 years
with a history of stroke compared
to those aged >85 years without
stroke
Pendlebury, UK Systematic 7511 patients with Pre-‐stroke and NA The pooled prevalence of pre-‐
2009 review and symptomatic stroke Post-‐stroke stroke dementia was higher
dementia (14.4%, 95% CI 12.0–16.8) in
meta-‐analysis hospital-‐based studies than in
Prevalence, (prevalence and
incidence, and population-‐based studies (9.1%,
risk factors) 6.9–11.3). Although post-‐stroke
factors associated
with pre-stroke (≤1 year) dementia rates were
and post-stroke heterogeneous overall, 93% of the
dementia: a variance was explained by study
systematic review methods and case mix; the rates
and meta-analysis ranged from 7.4% (4.8–10.0) in
population-‐based studies of fi rst-‐
ever stroke in which pre-‐stroke
dementia was excluded to 41.3%
(29.6–53.1) in hospital-‐based
studies of recurrent stroke in
which pre-‐stroke dementia was
included. The cumulative
incidence of dementia after the
first year was little greater (3.0%,
1.3–4.7) per year in hospital-‐based
studies than expected on the basis
of recurrent stroke alone. Medial


temporal lobe atrophy, female

sex, and a family history of
dementia were strongly
associated with pre-‐stroke
dementia, whereas the
characteristics and complications
of the stroke and the presence of
multiple lesions in time and place
were more strongly associated
with post-‐stroke dementia.
Gillespie, Australia Meta-‐analysis Right hemispheric Memory NA Recall, recognition The evidence for RHS non-‐verbal
2006 and Review stroke patients impairment and non-‐verbal memory deficits relative to LHS
memory tests. was mixed in the narrative review,
Memory whereas the meta-‐analysis found
impairment RHS deficits on non-‐verbal
following right recognition tests, but no
hemispheric difference between RHS and LHS
stroke: a patients on non-‐verbal recall tests.
comparative Deficits on recognition tests imply
meta-analytic and problems with early encoding of
narrative review material or possibly its storage.
Regarding verbal memory, the
narrative review found that RHS
patients performed more oorly
than NSCs in about half of all
studies. The meta-‐analytic review
confirmed poorer RHS
performance on tests of verbal
recall, but none of the studies that
compared RHS and NSCs on verbal
recognition could be included in
this type of review. The narrative
review found mixed evidence as
regards the performance of RHS
and LHS patients on verbal
memory tests, but the meta-‐
analysis pointed to RHS
superiority for both verbal recall


and recognition.
Mok, 2004 Hong Kong Observational 75 stroke patients; Cognitive 3 Mini-‐Mental State Among the 75 included patients,
42 healthy controls impairment and months Examination, 39 (52%) complained of cognitive
Cognitive determinants of Alzheimer’s Disease symptoms. The number of
impairment and Assessment Scale patients in each Clinical dementia
cognitive
functional (cognition subscale), rating scale (CDR) grading was as
outcome after
impairment Mattis Dementia follows: 39 (52%) had a CDR of 0,
stroke associated Rating Scale 26 (34.7%) had a CDR of 0.5, 10
with small vessel (initiation/perseveren (13.3%) had a CDR of >1. Pre-‐
disease ce subscale; MDRS stroke IQCODE and previous
I/P) stroke predicted CDR>1. The
NIHSS was associated with more
impaired BI. The NIHSS and MDRS
I/P contributed most to impaired
IADL.
Patel, 2003 UK Observational 163 first ever stroke Cognitive 3 years Mini-‐Mental State At three months, 1, 2 and 3 years
patients with follow-‐ impairment after Examination (MMSE) post stroke, the prevalence rates
Natural history of up stroke for cognition of cognitive impairment were
cognitive (cognitive 39%, 35%, 30% and 32%
impairment after impairment: respectively. Multivariable
stroke and factors MMSE<24), Barthel analyses showed that recovery
associated with and Frenchay activity was associated with smoking (OR
its recovery indices for disability. 3.7; 95% CI 1.2–11.8),
compromised by visuospatial
neglect (OR 0.27; 95% CI 0.08–
0.89), and had a near-‐significant
association with right hemispheric
lesion (OR 2.87; 95% CI 0.94–
8.78). Cognitive recovery was
associated with less
institutionalization (p = 0.032) and
being less disabled, on Barthel (p =
0.001) and Frenchay Activity
Indices (p = 0.028).
Tham, 2002 Singapore Observational 252 patients with TIA Prevalence and 1 year Vascular Dementia At baseline, 56% of patients were
or non-‐disabling natural history of Battery (assesses six ‘cognitively intact’, 40% were
Progression of ischemic stroke cognitive cognitive domains: ‘cognitively impaired but not
cognitive impairment attention, language, demented’ and 4% were


impairment after poststroke verbal memory (recall ‘demented’. At 1-‐year follow-‐up,
stroke: one year and recognition), 33% patients had a changed
results from a visual memory (recall classification from baseline. While
longitudinal study and recognition), 31% of those who were
of Singaporean visuoconstruction and ‘cognitively impaired but not
stroke patients visuomotor speed). demented’ at baseline improved
Dementia was to ‘cognitively intact’, 10% of the
diagnosed using the ‘cognitively intact’ group
DSM-‐IV criteria. deteriorated to ‘cognitively
Patients who did not impaired but not demented’ and
meet the DSM-‐IV 11% deteriorated from
criteria but were ‘cognitively impaired but not
impaired in one or demented’ to ‘demented’.
more cognitive Cognitive performance at baseline
domains were predicted for deterioration.
classified as
‘cognitively impaired
but not demented’.
Hoffmann, South Africa Observational 1,000 stroke patients We sought to NA A tiered, hierarchic, One or more higher cortical
2001 admitted to hospital determine the cerebrovascular function abnormalities was
frequency and investigative protocol detected in 607 (63.5%) of 955
Higher cortical extent of cognitive and a battery of nondrowsy patients. The most
function deficits disorders after predefined, validated numerous categories were
after stroke: an stroke and their bedside higher aphasias (25.2%), apraxias
analysis of 1,000 relation to stroke cortical function (14.5%), amnesias (11.6%), and
patients from a risk factors, deficit (HCFD) tests frontal network syndromes
dedicated syndromes, lesion with comparison to (9.2%), with the other categories
cognitive stroke site, and etiology. neuropsychological. less frequent (3%). Cognitive
registry impairment occurred without
elementary neurologic deficits
(motor, sensory, or visual
impairment) in 137 (22.5%) of
608.
Madureira, Portugal Observational 237 patients Dementia and 3 neuropsycho-‐ Disturbed performance on at least
2001 admitted to a Stroke cognitive months logical evaluation that one domain was detected on 131
Unit (mean age 59; impairment included the Mini-‐ (55%) patients: 27% had cognitive
Dementia and SD =12.7). poststroke Mental State deficits other than memory, 7%
cognitive Examination (MMSE), had focal memory deficit, 9% had


impairment three a complementary memory and other cognitive

months after battery to assess deficits and 6% had dementia.
stroke specific cognitive Dementia was associated with
domains, the female gender (P =0.01), older age
Hamilton Depression (P =0.01) and lower education
Rating Scale (HDRS) level (P =0.04). Patients with
and the Blessed memory deficits were older (P
Dementia Scale (BDS) =0.01) with lower educational
level (P =0.08) and more left sided
lesions (P= 0.02) than patients
without memory deficits. In this
middle aged stroke survivors
cognitive impairment was
common 3 months after stroke,
while dementia was infrequent.
Rockwood, Canada Observational 2859 participants, The prevalence ~ 5 Diagnostic methods Vascular cognitive impairment
2000 >65 years old and burden of years during clinical without dementia was the most
cognitive assessment included prevalent form of vascular
Prevalence and impairment administration of the cognitive impairment among
outcome of 3MS, section H of the those aged 65 to 84 years.
vascular cognitive Cambridge Mental Participants diagnosed with VCI
impairment Disorders of the during the initial CSHA survey
Elderly Examination, demonstrated an increased risk
and a battery of for institutionalization 5 years
neuropsychologic later (RR 3.1; range 2.1 to 4.6)
tests. compared with those with no
cognitive impairment. People
diagnosed with VCI at baseline
demonstrated an increased risk
for death 5 years later (RR 1.8;
range 1.5 to 2.3) compared with
cognitively normal people.
Cognitively normal people
without vascular risk factors lived
longer than did those with
vascular risk factors ( p = 0.04),
who in turn lived longer than did
individuals with nonvascular CIND


( p = 0.001) and vascular CIND ( p

= 0.001).
Hochstenbach, The Observational 229 patients with The following NA Neuropsychological More than 70% of the patients
1998 Netherlands stroke (18-‐70y) neuropsychological battery of tests showed a marked slowness of
‘‘domains’’ were information processing, whereas
Cognitive decline assessed: at least 40% of all patients had
following stroke: orientation, difficulty with memory,
a comprehensive memory, attention visuospatial and constructive
study of cognitive and concentration, tasks, language skills, and
decline following visuospatial and arithmetic. A significant effect was
stroke visuoconstructive found for side and type of stroke,
functions, gender, and the presence of
language, and aphasia. No significant effect was
arithmetic. found for cortical versus
subcortical lesions, having one
versus multiple strokes, having
lowered consciousness on
admission, the presence of risk
factors, a paresis of the hand, or
the interval between the stroke
and the neuropsychological
assessment.
Tatemichi, USA Observational 227 ischemic stroke Poststroke 3 17 scored items that The mean (SD) number of failed
1994 patients; 240 stroke-‐ cognitive months assessed memory, items was 3-‐4 (3.6) for patients
free controls impairment orientation, verbal with stroke and 0-‐8 (1.3) for
Cognitive skills, visuospatial controls (p < 0-‐001). Cognitive
impairment after ability, abstract impairment, defined as failure on
stroke: frequency, reasoning, and any four or more items, occurred
patterns, and attentional skills. (the in 35-‐2% of patients with stroke
relationship to 5th percentile was and 3-‐8% of controls (p < 0-‐001).
functional used for controls as Cognitive domains most likely to
abilities the criterion for be defective in stroke compared
failure on each item) with control subjects were
memory, orientation, language,
and attention. Among patients
with stroke, cognitive impairment
was most frequently associated
with major cortical syndromes and


with infarctions in the left anterior

and posterior cerebral artery
territories.
Ferro, 1988 Portugal Observational 254 patients aged 15-‐ Aphasia and >6 The comprehensive Compared with an older aphasic
50 years neuropsychological months neuropsychological population, young patients had
Young adult deficits battery included four significantly more nonfluent
stroke: subtests for aphasia; aphasias and fewer
neuropsychologic a 22-‐item version of comprehension deficits. These
al dysfunction and the token test; and differences were related to stroke
recovery tests of alexia; localization: the majority of
agraphia; buccofacial, infarcts localized by CT in 37
limb, and patients involved either the entire
constructional middle cerebral artery territory or
apraxia; and its superior or deep branches,
hemispatial neglect explaining the preponderance of
nonfluent aphasia. Prognosis of
aphasia in our patients was better
than has been reported for non-‐
age-‐selected aphasia populations.
Roughly one third of our patients
recovered completely, one third
improved, and one third had an
unresolved language deficit.
Complete recovery and significant
improvement were observed even
>6 months after stroke.


Grey Literature and Narrative Reviews

Pendlebury, 2009
Stroke-‐related dementia: rates, risk factors and implications for future research.
Stroke is a risk factor for dementia and dementia predisposes to stroke. Dementia prevalence in subjects with stroke is comparable to that seen in stroke-‐free
subjects who are 10 years older. However, until recently the prevalence, time course and risk factors for dementia in relation to the occurrence of stroke was
unclear owing to conflicting reports from individual studies. Data now available from a meta-‐analysis of studies of pre-‐ and post-‐stroke dementia, show that
heterogeneity between individual studies is largely explained by study methods and case-‐mix. Pooled dementia estimates are consistent with 1-‐in-‐10 patients
being demented prior to first stroke, 1-‐in-‐10 developing new dementia soon after first stroke, and over 1-‐in-‐3 being demented after a recurrent stroke. After
the first year, cumulative incidence of dementia is little greater than expected on the basis of recurrent stroke alone. Medial temporal lobe atrophy, female sex
and family history, are more strongly associated with pre-‐stroke dementia, whereas the characteristics and complications of the stroke and the presence of
multiple lesions in time and place are more strongly associated with post-‐stroke dementia, indicating the likely impact of optimal acute stroke care and
secondary prevention in reducing the burden of dementia. Future studies are needed to develop a predictive risk score for post-‐stroke dementia, to evaluate
short cognitive screening instruments to identify high risk patients with milder cognitive impairment, and to clarify the interaction between degenerative and
vascular processes in the development of dementia.
b) What is the impact of Neuropsychological/Neurocognitive deficits on stroke outcome?
Study Country Study Type Population Outcomes Follow Assessment Prevalence of outcomes
up tests used/
discussed
Racic, 2011 Bosnia and Observational 273 stroke patients Vascular dementia 3 months
National Institute of The mean value of the Barthel
Herzegovin poststroke Health National index in non-‐demented patients
Vascular Institute of was 88.66 with SD±12.65 and the
dementia: clinical
a Neurological confidence interval from 86.91 to
and Disorders and Stroke 90.42. A statistically significant
neuroradiological (NIH-‐NINDS), score difference was demonstrated in
correlation Mini Mental State the Barthel Index between the
Examination Score demented and non-‐demented
(MMSE), and patients (t=7.491, p<0.01).
Hachinski Ischemic
Score (HIS)
Toglia, 2011 USA Observational 72 inpatients with To compare Median= MMSE, MoCA, The MoCA classified more persons
stroke (mean age= Montreal Cognitive 8.5days motor FIM, motor as cognitively impaired than the


The mini-mental 70y with NIHSS=4 Assessment relative functional MMSE (89% vs 63%, respectively;
state examination and MMSE= 25) (MoCA) and Mini-‐ efficiency using a cutoff score of 27 on the
and Montreal Mental State MMSE and 26 on the MoCA). The
cognitive Examination MoCA also showed less of a ceiling
assessment in (MMSE) global and effect than the MMSE, higher
persons with mild subscores in internal reliability (Cronbach
subacute stroke: classifying ά=.78 compared with ά=.60), and
relationship to cognitive marginally stronger associations
functional impairment in with discharge functional status
outcome persons with mild (r=.40; P<.001) than the MMSE
stroke and to (r=0.30; P<.05). The MoCA
explore the visuoexecutive subscore was the
relationship strongest predictor of functional
between status (P=.01) and improvement
admission and (P=.02) in global and subscores for
discharge both tests.
functional status
and improvement.
Barker-Collo, New Observational 307 stroke patients Examined 5 years Consenting subjects Approximately half of 5-‐year
2010 Zealand with completed associations post were telephoned to stroke survivors in our sample
neuropsychological between complete the BI and perform within average limits on
Auckland stroke neuropsychological stroke Short Form–36 (SF-‐ neuropsychological tests, while a
tests and
outcomes study: deficits (memory, 36). Consistent with large proportion (~30%–50% on
questionnaires executive function, previous ARCOS most measures) experience
part 2: cognition
and functional information studies, BI scoring deficits particularly in executive
outcomes 5 years processing speed was from 0 to 20. and IPS domains. Being
poststroke [IPS], Participants were dependent/intermediate for basic
visuoperceptual/co then sent structured activities of daily living (BI) was
nstruction ability, self-‐administered associated with a score on the LHS
language), questionnaires that was 18.58 and 8.71 points
depression, and a (Patient Competency lower than for those who were
range of functional Rating Scale [PCRS], functionally independent.
outcomes and London Handicap Neuropsychological impairment is
their Scale [LHS]). independently associated with
interrelationships functional outcomes in the sample
Neuropsychological
5 years poststroke. assessed. In regression analyses,
testing was also visuoperceptual/construction
completed. abilities, visual memory, and IPS
made significant independent
contributions to functioning over
and above age, gender, education,
depression, and current BI.


Brodaty, 2010 Australia Observational 104 Ischemic stroke Mortality and Patient DSM-‐IV (Diagnostic In univariate analyses, a number
patients hospitalized, institutionalization were and Statistical of variables were predictive of
Mortality and with no evidence of Manual of Mental mortality, notably VaMCI, VaD,
institutionalizatio
assesse Disorders, 4th MMSE at 3-‐6 months, ADL/IADL at
prior dementia; 76
n in early d for 5 edition) diagnosis of 3-‐6 months, education, NARTIQ,
survivors of
comparison subjects mental retardation, stroke severity, depression,
years
stroke: the effects severe aphasia apathy, not married, and alcohol
after
of cognition, (score of, on the abuse. All of these predictors
vascular mild stroke; Aphasia Severity remained significant when
cognitive deaths Rating Scale of the corrected for age with the
impairment and Boston Diagnostic exception of stroke severity,
were
vascular Aphasia apathy, depression, and not
dementia recorde Examination), married. In univariate analyses,
d up to Activities of Daily VaD (but not VaMCI or MMSE),
10 Living (ADL) and ADL/IADL score, stroke severity,
years Instrumental depression, and not married were
Activities of Daily significant predictors of nursing
Living (IADL) scales, home admission. All of these
and the Mini-‐Mental predictors remained significant
State Examination when corrected for age with the
(MMSE). exception of apathy, depression,
and not married. By the end of the
last follow-‐up (at 10.1 years [527
weeks]), 42 subjects (23.2%) had
been placed in a nursing home.
Cederfeldt, Sweden Observational 45 elderly post-‐ To examine 12 Barthel Index, The Between discharge and 6 months,
2010 stroke patients (age whether there months Mini Mental State the persons with intact prestroke
>65) were any Examination, cognition (n = 23) had improved
Recovery in differences in the Cognitive significantly in P-‐ADL (P = 0.001),
personal care recovery in impairment while those with prestroke
related to performance of questionnaire cognitive impairments (n = 18)
cognitive personal activities (CIMP-‐QUEST) had not. In addition, the persons
impairment of daily living (P-‐ neuropsychological with intact prestrike cognition
before and after ADL) in elderly tests; The National displayed significantly higher BI
stroke- a 1 year persons in relation Institute of Health ratings at 6 months compared
follow-up to cognitive Stroke Scale was with the persons with prestroke
impairments pre-‐ used to measure cognitive impairments (P = 0.028).
and post-‐stroke neurological deficits. Between discharge and 12
months, the persons with intact
prestroke cognition improved
significantly in P-‐ADL (P = 0.001),
while the persons with prestroke


cognitive impairments did not.
Further, the persons with intact
prestroke cognition displayed
significantly higher BI scores at 12
months compared with the
persons with prestroke cognitive
impairments (P = 0.027). There
was also a correlation between
prestroke cognitive status and
prestroke P-‐ADL, r = -‐0.375** (P =
0.003).
Narasimhalu, Singapore Observational 419 without dependency, Mean= Neuropsychology In multivariate analysis, age,
2010 dementia (mean age vascular outcomes, 3.2 test battery, MMSE stroke subtype, diabetes mellitus,
60+11 years, 32% and death years and all definitions of cognitive
The prognostic impairment were significant
female)
effects of predictors of dependency. In
poststroke univariate analysis, age, diabetes
cognitive mellitus, CIND, and CIND severity
impairment no were associated with recurrent
dementia and vascular events. However, there
domain-specific were no significant predictors of
cognitive recurrent vascular events in
impairments in multivariate analysis. In univariate
nondisabled analysis, age, gender, diabetes
ischemic stroke mellitus, hypertension, and
patients cognitive impairments were
associated with death. In
multivariate analysis predicting for
death, age, diabetes mellitus, and
CIND-‐moderate were all
significant predictors of death.
Narasimhalu, Singapore Observational 362 ischemic stroke Mild cognitive Mean= Neuropsychology In univariate analysis, older
2009 patients impairment, 3.4 test battery, patients, patients with prior
years strokes, patients who experienced
cognitive MMSE another stroke, as well as those
Severity of CIND
and MCI predict impairment no with more severe baseline
incidence of dementia, cognitive impairment (CIND
dementia in an moderate, hazard ratio [HR]=
dementia
ischemic stroke 22.5, confidence interval [CI]
cohort 5.22–97.2, in CIND severity;
multiple domain MCI with
amnestic component, HR =19.3, CI


4.48 – 83.4; and nonamnestic
multiple domain MCI, HR =7.87, CI
1.11–55.9, in MCI subtypes, and
MMSE, HR= 0.91, CI 0.83– 0.99)
were at higher risk of conversion
to dementia.
In multivariable analysis
controlling for treatment
allocation, age (HR= 1.08, CI 1.03–
1.14), occurrence of a previous
stroke (HR =3.01, CI 1.18–7.67),
occurrence of another stroke (HR=
2.45, CI 1.02–5.92), and baseline
cognitive status as defined by
either CIND moderate (HR= 6.43,
CI 1.30–31.7) or multiple domain
MCI with amnestic component
(HR =5.77, CI 1.19 –28.0) were
significant predictors of dementia
Barker-Collo, New Review Post-‐stroke Functional NA NA The literature reviewed indicates
2006 Zealand population Outcome that post-‐stroke deficits in
executive function, memory,
The impact of language, and speed of processing
neuropsychologic are common, with those identified
al deficits on as having progressive ‘post-‐stroke
functional stroke dementia’ presenting with a
outcomes similar, though more impaired
profile, with increased
impairments particularly noted in
the area of memory. It is clear that
some aspects of
neuropsychological functioning
(e.g., presence of neglect, aphasia,
anosognosia; and verbal memory
and attention deficits) show
promise as a means of predicting
post-‐stroke functional outcomes.
Examining the available literature,
it becomes evident that there is a
need for long-‐term, large scale
(i.e., population based) follow-‐up
studies, evaluating likely long-‐


term neuropsychological
outcomes of stroke and their
prognostic utility.
Van The Observational 57 patients with first Functional 12-‐24 neuropsychological In the early stage 44 (77%),
Zandvoort, Netherlands ischaemic stroke (age outcome after months screening battery patients could complete 82% of
19-‐80, mRS 2-‐4) stroke (intellectual the administered tasks. At second
2005
functioning, evaluation, test performances
language, memory, improved, but a stable test profile
Early
perception and was found with respect to
neuropsycholgical
visuospatial abnormalities on the different
evaluation in
construction), BI and tasks (P < 0.0001). Moreover,
patients with
mRS, 36-‐item short initial sum scores of all composite
ischaemic stroke
provides valid
form of the Medical cognitive domains including
information
Outcome Study intellectual functioning (R2 =
questionnaire (MOS-‐ 0.80), language (R2 = 0.76),
SF-‐36), Visual analog memory (R2 = 0.32), perception
scale, post-‐stroke and visuospatial construction (R2
depression rating = 0.60), attention and
scale psychomotor-‐functioning (R2 =
0.80) had significant predictive
validity with respect to functional
outcome (P < 0.001).
Mok, 2004 Hong Kong Observational 75 stroke patients; Cognitive 3 Mini-‐Mental State Multivariate regression analysis
42 healthy controls impairment and months Examination, revealed that only NIHSS
Cognitive determinants of Alzheimer’s Disease (R2=0.096, p=0.011) contributed
impairment and Assessment Scale significantly to the variance of BI.
cognitive
functional (cognition subscale), Univariate analysis revealed that
outcome after
impairment Mattis Dementia age, education, NIHSS, pre-‐stroke
stroke associated Rating Scale IQCODE, WMC, and performance
with small vessel (initiation/ on all the three psychometric tests
disease perseverance were associated with IADL.
subscale; MDRS I/P) Multivariate regression analysis
revealed that NIHSS (R2=0.327,
p<0.001), performance on MDRS
I/P (R2=0.139, p<0.001), age
(R2=0.052, p=0.011), and pre-‐
stroke IQCODE (R2=0.034,
p=0.034) contributed significantly
to the variance of IADL
Zinn, 2004 USA Observational 272 stroke patients To determine 6 Rehabilitation Compliance with guidelines and
that were eligible for whether cognitive process variables receipt of and interval to
rehabilitation impairment affects were examined for postacute treatment initiation did


The effect of access to, or months patients assessed as not differ between cognitively
poststroke quality of, cognitively impaired impaired and unimpaired patients.
cognitive rehabilitation or unimpaired Although most cognition-‐related
impairment on services, and to according to treatment elements were similar
rehabilitation examine the education-‐adjusted for both groups, cognitive goals
process and effects of Mini-‐Mental State were more frequently charted in
functional functional Examination score. impaired patients. Controlling for
outcome outcomes in stroke Functional outcomes baseline function and
patients. were performance rehabilitation process, cognitively
of activities of daily impaired patients had worse IADL
living (ADLs), performance at 6 months than did
measured by the unimpaired patients; cognition did
FonFIM, and not significantly influence ADL
instrumental performance.
activities of daily
living (IADLs),
measured by Lawton
Patel, 2003 UK Observational 163 first ever stroke Cognitive 3 years Mini-‐Mental State At three months, 1, 2 and 3 years
patients with follow-‐ impairment after Examination (MMSE) post stroke, the prevalence rates
Natural history of up stroke for cognition of cognitive impairment were
cognitive (cognitive 39%, 35%, 30% and 32%
impairment after impairment: respectively. Multivariable
stroke and factors MMSE<24), Barthel analyses showed that recovery
associated with and Frenchay was associated with smoking (OR
its recovery activity indices for 3.7; 95% CI 1.2–11.8),
disability. compromised by visuospatial
neglect (OR 0.27; 95% CI 0.08–
0.89), and had a near-‐significant
association with right hemispheric
lesion (OR 2.87; 95% CI 0.94–
8.78). Cognitive recovery was
associated with less
institutionalization (p = 0.032) and
being less disabled, on Barthel (p =
0.001) and Frenchay Activity
Indices (p = 0.028).
Paollucci, Italy Observational 178 patients with To assess the 8 weeks Patients were Compared with USN-‐negative
2001 first stroke; matched specific influence assessed with patients, USN_ patients had
comparisons of unilateral spatial neurologic significantly more severe baseline
The role of neglect (USN) on (Canadian neurologic and functional status at
unilateral spatial rehabilitation Neurological Scale), admission, less effectiveness and
outcome. (Length neuropsychiatric efficiency on activities of daily


neglect in of stay, efficiency (Hamilton living (ADLs) and mobility, a higher
rehabilitation of (average daily Depression Rating percentage of low responders,
right brain- increase in Barthel Scale), longer hospitalization, a higher
damaged Index), neuroradiologic, and percentage of persistent
ischemic stroke effectiveness functional (Barthel incontinence at discharge (20.5%
patients: a (amount of Index, Rivermead vs 4.9%), and a lower percentage
matched potential Mobility Index of high responders and patients
comparison improvement [RMI]) examinations. returning home. The presence of
achieved during USN was incompatible with a high
rehabilitation) of therapeutic response, for both
treatment and ADLs (OR= 2.94, 95% confidence
percentage of low-‐ interval [CI] 1.05– 8.20; b
and high-‐response +standard error= 1.08 +.52, p <
patients calculated .05), and mobility (OR =7.16, 95%
on the Barthel CI 2.78 –18.44; b =1.97 +.52, p<
Index and the RMI, .001) and was a relevant
and percentage of prognostic factor for institutional
urinary discharge (OR =5.62, 95% CI 1.63–
incontinence and 19.38; b =1.73 + .63, p< .01,
return home were accuracy 88.41%).
evaluated.)
Rockwood, Canada Observational 2859 participants, The prevalence ~ 5 years Diagnostic methods Vascular cognitive impairment
2000 >65 years old and burden of during clinical without dementia was the most
cognitive assessment included prevalent form of vascular
Prevalence and impairment administration of cognitive impairment among
outcome of the 3MS, section H those aged 65 to 84 years.
vascular cognitive of the Cambridge Participants diagnosed with VCI
impairment Mental Disorders of during the initial CSHA survey
the Elderly demonstrated an increased risk
Examination, and a for institutionalization 5 years
battery of later (RR 3.1; range 2.1 to 4.6)
neuropsychologic compared with those with no
tests. cognitive impairment. People
diagnosed with VCI at baseline
demonstrated an increased risk
for death 5 years later (RR 1.8;
range 1.5 to 2.3) compared with
cognitively normal people.
Cognitively normal people without
vascular risk factors lived longer
than did those with vascular risk
factors ( p = 0.04), who in turn


lived longer than did individuals
with nonvascular CIND ( p = 0.001)
and vascular CIND ( p = 0.001).
Tatemichi, USA Observational 227 ischemic stroke Poststroke 3 17 scored items that Functional impairment was
1994 patients; 240 stroke-‐ cognitive months assessed memory, greater with cognitive
free controls impairment orientation, verbal impairment, and dependent living
Cognitive skills, visuospatial after discharge either at home or
impairment after ability, abstract nursing home was more likely
stroke: frequency, reasoning, and (55.0% with, v 32-‐7% without
patterns, and attentional skills. cognitive impairment, p = 0-‐001).
relationship to (the 5th percentile In a logistic model examining the
functional was used for risks related to dependent living
abilities controls as the after stroke, cognitive impairment
criterion for failure was a significant independent
on each item) correlate (odds ratio, OR = 2-‐4),
after adjusting for age (OR = 5'2,
80 + v 60-‐70 years) and physical
impairment (OR = 3.7, Barthel
index < 40 v > 40).
c) What tools are used to assess VCI?

Braun, 2012

Literature search showed >1700 peer-‐reviewed studies on neuropsychological function after stroke. Poststroke rehabilitation planning is strongly aided by
neuropsychological assessment results, which offer detailed information about cognitive and functional abilities, inform rehabilitation treatments, and predict
functional outcome. The predictions remain accurate even 5 years poststroke.

Gottesman, 2010
Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke
Stroke remains a primary cause of morbidity throughout the world mainly because of its effect on cognition. Individuals can recover from physical disability
resulting from stroke, but might be unable to return to their previous occupations or independent life because of cognitive impairments. Cognitive dysfunction
ranges from focal deficits, resulting directly from an area of infarction or from hypoperfusion in adjacent tissue, to more global cognitive dysfunction. Global
dysfunction is likely to be related to other underlying subclinical cerebrovascular disease, such as white-‐matter disease or subclinical infarcts. Study of cognitive
dysfunction after stroke is complicated by varying definitions and lack of measurement of cognition before stroke. Additionally, stroke can affect white-‐matter


connectivity, so newer imaging techniques, such as diffusion-‐tensor imaging and magnetisation transfer imaging, that can be used to assess this subclinical
injury are important tools in the assessment of cognitive dysfunction after stroke. As research is increasingly focused on the role of preventable risk factors in
the development of dementia, the role of stroke in the development of cognitive impairment and dementia could be another target for prevention.

*Nyenhuis, 2007
Diagnosis and management of vascular cognitive impairment
Accurate diagnosis of vascular cognitive impairment (VCI) is important but may be difficult. VCI diagnoses depend on determinations of the presence of both
cognitive impairment and cerebrovascular disease (CVD), temporal causal links between cognitive impairment and CVD, and the presence or absence of other
potential contributors to cognitive impairment, such as Alzheimer’s disease (AD). Diagnostic criteria differ across currently utilized systems, resulting in widely
differing VCI prevalence rates. Also, current systems may not be able to differentiate “pure” VCI from “mixed” AD and CVD. National Institute of Neurological
Disorders and Stroke harmonization criteria for VCI have been developed for study and validation to help bridge gaps in our understanding of VCI diagnosis. VCI
management begins with atherogenic risk factor control. Current VCI treatment options demonstrate statistical improvement but not consistent global clinical
efficacy. Future clinical trials should concentrate on both primary risk factor control and development of new therapeutic agents to treat patients already
diagnosed with VCI.

Hachinski, 2006
National Institute of Neurological Disorders and Stroke-‐ Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards
VCI encompasses a large range of cognitive deficits, from relatively mild VCI no dementia to more severe vascular dementia, or combined cerebrovascular
disease with other dementing conditions, such as AD.23 The pattern of VCI cognitive deficits may include all cognitive domains, but there is likely to be a
preponderance of so-‐called “executive” dysfunction, such as slowed information processing, impairments in the ability to shift from one task to another, and
deficits in the ability to hold and manipulate information (ie, working memory). Neuropsychological protocols must therefore be both sensitive to a wide range
of abilities and especially attuned to the assessment of executive function. Timed executive function tests may be especially sensitive to VCI-‐related
impairment because of the slowed information processing noted in this patient sample. 60-‐minute, 30-‐minute, and 5-‐minute assessment protocols are
proposed.
d) Imaging
up tests used/
discussed


Gorelick, 2011 Internation AHA/ASA Stroke Patients Imaging factors NA Imaging The clinical presentation and
al statement; that may influence course of CVBI are highly variable,
Vascular the clinical with the classic phenotype of
contributions to
Review presentation and stepwise decline in association
cognitive course of VCI with stroke10 being a relatively
impairment and uncommon presentation for VCI.
dementia Structural MRI provides a fairly
sensitive and specific marker for
CVBI, but the relationship
between CVBI and cognitive
impairment is confounded by the
frequent presence of Alzheimer
disease changes of the brain and
co-‐occurrence of depression on a
cerebrovascular basis. Recent data
from prospective population-‐
based samples (where the
likelihood of Alzheimer disease is
relatively low) clearly show that
progressive SBI and WMLs are
correlated with worsening of
cognitive impairment, especially
executive function.
Debette, 2010 USA Observational 1694 participants Incident stroke, The mean Dementia was Extensive white matter
aged 62+9 years dementia, and duration diagnosed according hyperintensities (WMHV) and
Association of mortality of follow-‐ to the criteria of the MRI-‐defined brain infarcts (BI)
up was
MRI markers of Diagnostic and were associated with an increased
5.6+1.4
vascular brain years for Statistical Manual of risk of stroke (hazard ratio
injury with stroke, Mental [HR]=2.28, 95% CI: 1.02 to 5.13;
incident stroke, 5.9+1.4 Disorders, 4th HR=2.84, 95% CI: 1.32 to 6.10).
mild cognitive years for Edition; WMHV, extensive WMHV, and BI
impairment, dementia were associated with an increased
dementia, and , and risk of dementia (HR=2.22, 95% CI:
mortality: the 5.2+1.5 1.32 to 3.72; HR=3.97, 95% CI:
Framingham years for 1.10 to 14.30; HR=6.12, 95% CI:
offspring study mortality 1.82 to 20.54) independently of
and vascular risk factors and interim
6.2+1.2 stroke. WMHV and extensive
years for WMHV were associated with
MCI incident amnestic mild cognitive
impairment in participants
aged>60 years only (OR=2.47, 95%


CI: 1.31 to 4.66 and OR=1.49, 95%
CI: 1.14 to 1.97). WMHV and
extensive WMHV were associated
with an increased risk of death
(HR=1.38, 95% CI: 1.13 to 1.69;
HR=2.27, 95% CI: 1.41 to 3.65)
independent of vascular risk
factors and of interim stroke and
dementia.
Rasquin, 2004 The Observational 176 patients with Vascular cognitive 12 CT Scans, At one month none of the
first ever brain impairment, months neuropsychological variables were predictors of
Netherlands post-‐
Demographic and infarct (>40 years Cognitive test batter dementia; at six months older age
stroke
CT scan features performance over (odds ratio (OR) 9.4), low
old, MMSE >15, no
related to time education (OR 14.7), and
cognitive
pre-‐stroke dementia) territorial infarct (OR 10.6)
impairment in the predicted dementia; and at 12
first year after months low education (OR 8.7)
stroke and pre-‐stroke cerebrovascular
damage (OR 7.4) predicted
dementia. Predictors of VCI were
low education (OR 3.4) and
territorial infarct (OR 2.4) at one
month post stroke; older age (OR
4.3) and low education (OR 4.1) at
six months; and older age (OR 3.5)
at 12 months. Predictors of
vascular MCI were low education
(OR 4.96) and territorial infarct
(OR 3.58) at one month; and older
age and lower education at six
months (OR 3.4 and 3.7,
respectively) and at 12 months
(OR 3.5 and 2.28, respectively).
Vermeer, The Observational 1015 participants Dementia Mean=3. MRI, the Mini– Dementia developed in 30 of the
(60-‐90y, stroke and 6 years Mental State 1015 participants. The presence of
2003 Netherlands
dementia free at Examination, the 15-‐ silent brain infarcts at base line
Silent brain word verbal learning more than doubled the risk of
baseline)
infarcts and the test, the Stroop test, dementia (hazard ratio, 2.26; 95
risk of dementia the Paper-‐and-‐Pencil percent confidence interval, 1.09
and cognitive Memory Scanning to 4.70). The presence of silent
Task, and the Letter– brain infarcts on the base-‐line MRI
Digit Substitution was associated with worse


decline Task. performance on
neuropsychological tests and a
steeper decline in global cognitive
function. Silent thalamic infarcts
were associated with a decline in
memory performance, and
nonthalamic infarcts with a
decline in psychomotor speed.
When participants with silent
brain infarcts at base line were
subdivided into those with and
those without additional infarcts
at follow-‐up, the decline in
cognitive function was restricted
to those with additional silent
infarcts.

Black, 2009
Understanding White Matter Disease: imaging-‐pathological correlations in vascular cognitive impairment
Most strokes are covert and observed incidentally on brain scans, but their presence increases risk of overt stroke and dementia. Amyloid angiopathy,
associated with Alzheimer Disease (AD) causes stroke, and when even small strokes coexist with AD, they lower the threshold for dementia. Diffuse ischemic
white matter disease impairs executive functioning, information processing speed, and gait. Neuroimaging techniques, such as tissue segmentation, Diffusion
Tensor Imaging, MR Spectroscopy, functional MRI and amyloid PET, probe microstructural integrity, molecular biology, and activation patterns, providing new
insights into brain-‐behavior relationships. MR-‐pathological studies of periventricular hyperintensity (leukoaraiosis) in aging and dementia reveal arteriolar
tortuosity, reduced vessel density, and occlusive venous collagenosis which causes venous insufficiency and vasogenic edema. Activated microglia,
oligodendroglial apoptosis, clasmatodendritic astrocytosis, and upregulated hypoxia-‐markers are seen on immunohistochemistry. Further research is needed
to understand and treat this chronic subcortical vascular disease, which is epidemic in our aging population.
Hachinski, 2006
National Institute of Neurological Disorders and Stroke-‐ Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards
The main role of neuroimaging in the study of VCI so far has been to describe the brain, not diagnose it. Thus, neuroimaging plays a fundamentally different
role in the study of VCI than it does in other conditions. This focus on description rather than diagnosis results from the facts that (1) vascular and degenerative
pathology frequently coexist, and (2) there are no pathognomonic radiological features of VCI. Different researchers have used a variety of terms and
definitions to describe the changes in the brains of people with VCI, making comparison between studies difficult; this in turn has limited the understanding of


the neuroimaging features of this condition. The use of a common minimal research data set with standardized terminology in all clinical studies can help
overcome this obstacle.
e) Cognitive tests
up tests used/
discussed
Cumming, Internation Observational 294 stroke patients MoCA feasability 3 The MoCA includes Of those surviving to 3 months,
2011 al patients (85% months sections on the MoCA was completed by 87%
ischemic) with mean visuospatial/ with mild stroke, 79% with
The Montreal executive, naming, moderate stroke, and 67% with
age of 70.6 years (SD,
cognitive attention, language, severe stroke on admission.
12.8) abstraction, delayed Mean MoCA score was 21.1 (SD
assessment short
cognitive recall, and 7.5) out of 30; only 78 of 220
evaluation in a orientation. It is (35%) patients attained the
large stroke trial scored out of 30 “normal” cutoff (>26). This study
(extra point for <13 demonstrates that administering
years’ education) the MoCA at 3 months poststroke
and the is feasible.
recommended
“normal” cutoff is
>26.
Kornery- Canada Survey 633 occupational Type and NA Clinicians indicated Respectively, 69%, 83% and 31%
Bitensky, therapists in Canada frequency of using 56 different of occupational therapists
cognition-‐related assessments. responding to the acute care,
2011
problem inpatient rehabilitation and
identification, community-‐based vignettes
National survey of
assessment and recognized cognition as a
Canadian
intervention use. potential problem. Standardised
occupational
assessment use was prevalent:
therapists’
70% working in acute care, 77% in
assessment and
treatment of
inpatient rehabilitation and 58% in
cognitive
community-‐based settings
impairment post-
indicated using standardised
stroke assessments: 81%, 83% and 50%,
respectively, indicated using
general cognitive interventions.
The Mini-‐Mental State
Examination was often used


up tests used/
discussed
incorrectly to monitor patient

change. Executive function, a
critical component of post-‐stroke
assessment, was rarely addressed.
Interventions were most often
general (e.g. incorporated in
activities of daily living) rather
than specific (e.g. cueing, memory
aids, computerbased retraining).
Racic, 2011 Bosnia and Observational 273 stroke patients Vascular dementia 3 months National Institute of The mean value of the NIH-‐NINDS
Herzegovin poststroke Health National scores in the non-‐demented
Vascular Institute of patients was 11.93 with SD±6.37
dementia: clinical
a Neurological and confidence interval from
and Disorders and Stroke 11.05 to 12.81. A statistically
neuroradiological (NIH-‐NINDS), score significant difference was
correlation Mini Mental State demonstrated in the NIH-‐NINDS
Examination Score scores between the demented
(MMSE), and and the non-‐demented patients
Hachinski Ischemic (t=4.330, p<0.01). The mean value
Score (HIS), BI of MMSE scores in the demented
patients was 15.51 with SD±6.05
and the confidence interval from
13.77 to 17.25.
The mean value of MMSE
scores in the non-‐demented
24.94 to 27.01. A statistically
significant difference was
demonstrated in the MMSE scores
between the demented and non-‐
demented patients (t=9.109,
p<0.01). The mean value of the
Barthel index in the demented
65.98 to 77.28.


up tests used/
discussed
The mean value of the Barthel

index in non-‐demented patients
was 88.66 with SD±12.65 and the
confidence interval from 86.91 to
90.42. A statistically significant
difference was demonstrated in
the Barthel Index between the
demented and non-‐demented
patients (t=7.491, p<0.01).
Toglia, 2011 USA Observational 72 inpatients with To compare Median= MMSE, MoCA, The MoCA classified more persons
stroke (mean age= Montreal Cognitive 8.5days motor FIM, motor as cognitively impaired than the
The mini-mental 70y with NIHSS=4 Assessment relative functional MMSE (89% vs 63%, respectively;
state examination (MoCA) and Mini-‐ efficiency using a cutoff score of 27 on the
and MMSE= 25)
functional status
and improvement.
Verhoeven, The Observational 134 poststroke The objective of 3 years Cambridge Cognitive One year poststroke, the CAMCOG
2011 Netherlands patients this study was to Examination dimensions of orientation (b = –
investigate the (CAMCOG), Stroke-‐ 0.21), Perception (b = – 0.16) and
The predictive value of screening Adapted Sickness Memory (b= – 0.16), as well as age
value of cognitive for cognitive Impact Profile and motor function were
impairments functions at the significant predictors of health
measured at the start of an status. Cognitive variables alone
start of clinical inpatient explained 2.5–10.3% of the


up tests used/
discussed
rehabilitation for rehabilitation variance. Three years poststroke,

health status 1 programme to CAMCOG Perception (b= – 0.19
year and 3 years predict the health and – 0.18) and Language (b = –
poststroke status 1 and 3 0.15), as well as age, type of
years poststroke. stroke and motor function were
significant predictors of health
status, and the cognitive variables
alone explained 1.7–10.9% of the
variance. CAMCOG scores were
significant predictors of long-‐term
health status in patients with
stroke, although the amount of
explained variance was small.
Azevedo da Brazil Observational 42 patients (age 40-‐ The aim of this 6 MMSE The MMSE total score separate
Costs, 2010 90) from work was to months analysis in terms of evolution of
rehabilitation investigate the these scores, showed significance
Cognitive cognitive evolution only for the schooled individuals
outpatient centers
evolution by (overall and (P=0.008), but not for the illiterate
MMSE in specific items of individuals (P=0.440). Considering
poststroke MMSE) and clinical the clinical severity, significant
patients severity of evolution was observed for both
illiterate and the schooled and the illiterate
schooled individuals (P<0.001). The
postacute stroke cognitive domains, when analyzed
patients separately, showed for the
schooled individuals, a significant
evolution for the spatial
orientation and language domains
(P=0.010). A negative correlation
(r= – 0.47) was found between
cognitive (MMSE) and clinical
(NIHSS) evolutions for the
schooled individuals (P=0.01). This
relationship was not observed in
the illiterate individuals
(P=0.382)


up tests used/
discussed
Bour, 2010 The Observational 194 consecutive Cognitive 24 MMSE, DSM-‐IV The MMSE score 1 month after
Netherlands patients admitted functioning (A months diagnostic criteria stroke predicted cognitive
How predictive is with supratentorial score lower than for dementia, functioning at later follow-‐up
the MMSE for stroke (age> 40, the 10th percentile standardized Dutch visits. It could not predict
cognitive of the score of the translation of the deterioration or improvement in
adequate post-‐stroke
performance after norm group MMSE and a cognitive functioning over time.
stroke?
fluency in dutch and defined a deficit on neuropsychological The cut-‐off score in the screening
an initial post-‐stroke a cognitive test battery for 1 cognitive disturbed domain
MMSE >15) domain) consisting of the was 27/28 with a sensitivity of
following tests: 0.72. The cut-‐off score in the
CAMCOG, Concept screening for at least 4 impaired
Shifting Test, Stroop domains and dementia were
Colour Word Test, 26/27 and 23/24 with a sensitivity
Auditory Verbal of 0.82 and 0.96, respectively. The
Learning test and results indicated that the MMSE
the Groninger has modest qualities in screening
Intelligence Test for mild cognitive disturbances
and is adequate in screening for
moderate cognitive deficits or
dementia in stroke patients 1
month after stroke. Poor
performance on the MMSE is
predictive for cognitive
impairment in the long term.
However, it cannot be used to
predict further cognitive
deterioration or improvement
over time.
Gottesman, USA Observational 200 patients with Lesion size, stroke NA NIHSS-‐Plus The NIHSS predicted DWI volume
2010 acute non-‐dominant severity, in a univariate analysis, as did
hemispheric stroke perceptual deficits total line cancellation and a visual
The NIHSS-PLUS: perception task. In a multivariate
improving model, using log-‐transformed
cognitive variables, the NIHSS (p=0.0002),
assessment with line cancellation errors (p=0.02)
the NIHSS and visual perception (p=0.004)
each improved prediction of total


up tests used/
discussed
infarct volume. We propose that

these two cognitive tests, which
together can be completed in 2-‐3
minutes, could be combined with
the NIHSS to create an “NIHSS-‐
plus” that more accurately
represents a patient’s ischemic
tissue volume after a stroke. This
scale requires further validation in
a prospective study.
Stricker, 2010 USA Observational 42 stroke patients Cognitive NA Neuropsychological The stroke group performed more
with radiologically impairment Assessment Battery poorly than the control group
Utility of the confirmed unilateral (NAB) across NAB Total score and all five
neuropsychologic damage; 36 Domain scores (p<0.001). Receiver
al assessment demographically operator curves (ROC) were
battery in matched controls derived and area under the curve
detecting (AUC) showed moderate
cognitive diagnostic effectiveness (AUC .70
impairment after to .90) for NAB Total score, all fi ve
unilateral stroke Domain scores, a motor
composite, and a Global Deficit
Score (GDS) that has been shown
to closely approximate clinical
ratings of neuropsychological
impairment. The NAB Total, GDS,
and motor composite had
comparable clinical utility,
whereas the Attention and
Executive domain scores
demonstrated better classification
utility compared with the Memory
domain.
Wolf, 2010 USA Observational 20 patients with mild The goal of this 6 Executive Function The goal of this study was to test
to moderate stroke study was to test months Performance the feasibility of administering
Feasibility of the feasibility of post Test (EFPT) subtests of the EFPT to stroke
using the EFPT to administering survivors in the acute phase of
detect executive subtests of the stroke to detect executive


up tests used/
discussed
function deficits EFPT to stroke stroke function deficits. Performance on
at the acute stage survivors in the the EFPT one-‐week post stroke
of stroke acute phase of was very similar to what was
stroke to detect found in a prior study validating
executive function the EFPT in stroke survivors at 6-‐
deficits months post-‐onset.
Yip, 2010 China Observational/ 66 poststroke Cognitive 7 days MMSE (Chinese The internal consistency of the
validation study patients (>60y) impairment version), Intelligent ICAS (Cronbach’s ά=0.878) and its
Validation of the cognitive test–re-‐test reliability (ά=0.789;
intelligent assessment system p<0.001) were demonstrated. The
cognitive (ICAS) cut-‐off score for the ICAS to
assessment determine cognitive impairment
system (ICAS) for was found to be 3.02, with a
stroke survivors sensitivity of 80.5% and specificity
of 96%. The ICAS also showed
good correlation with MMSE-‐CV
(ρ=0.757; p<0.001).
Douglas, 2007 Canada Survey 247 occupational Standardised and NA Respondents Therapists used more bottom-‐up
therapists in Canada non-‐standardised reported using 75 assessments that were
Cognitive assessments used standardised and standardized, identified deficits,
assessments for by occupational non-‐standardised and easy to administer. They used
older adults: therapists to measures. more top-‐down assessments that
which ones are evaluate cognition were non-‐standardised, predicted
used by Canadian function, and fit with their
therapists and theoretical approach.
why
Van The Observational 57 patients with first Functional 12-‐24 neuropsychological In the early stage 44 (77%),
Zandvoort, Netherlands ischaemic stroke (age outcome after months screening battery patients could complete 82% of
19-‐80, mRS 2-‐4) stroke (intellectual the administered tasks. At second
2005
functioning, evaluation, test performances
language, memory, improved, but a stable test profile
Early
perception and was found with respect to
neuropsycholgical
visuospatial abnormalities on the different
evaluation in
construction), BI and tasks (P < 0.0001). Moreover,
patients with
mRS, 36-‐item short initial sum scores of all composite
ischaemic stroke
form of the Medical cognitive domains including


up tests used/
discussed
provides valid Outcome Study intellectual functioning (R2 =

information questionnaire (MOS-‐ 0.80), language (R2 = 0.76),
SF-‐36), Visual analog memory (R2 = 0.32), perception
scale, post-‐stroke and visuospatial construction (R2
depression rating = 0.60), attention and
scale psychomotor-‐functioning (R2 =
0.80) had significant predictive
validity with respect to functional
outcome (P < 0.001).
Stephens, UK Observational Stroke patients (>75); to establish if the 3 A detailed battery of Deficits of attention (z=5.7;
2004 66 age matched potential value of months neuropsychological p<0.0001) and executive function
controls vascular CIND is a assessments (z=5.9; p<0.0001) were seen even
Neuropsychologic useful concept for in stroke patients without vascular
al characteristics predicting further CIND, compared to controls.
of mild vascular cognitive decline However, stroke patients with
cognitive and dementia in CIND were significantly more
impairment and stroke patients impaired again on tests of
dementia after executive function (z=10.3;
stroke p<0.0001) compared to those not
meeting CIND criteria; and also
had greater impairments of
memory (z=10.4; p<0.0001) and
language expression (z=10.1;
p<0.0001). A similar overall profile
of deficits was evident in the CIND
and the dementia group, but
specific deficits were significantly
more pronounced in those with
dementia, particularly in
orientation (z=7.2; p<0.0001) and
memory (z=5.8; p<0.0001).
Ingles, 2002 Canada Observational 102 subjects from Progression from 5 years Neuropsychological Forty-‐four percent (n=45) of our
the Canadian study vascular cognitive test battery, sample had progressed to
Neuropsychologic of health and aging, impairment, no modified mini-‐ dementia within 5 years. Of those
al predictors of >65 years, with CIND dementia to mental state who progressed and were alive at
incident dementia dementia follow-‐up, 43% (n=10) were
in patients with diagnosed with VaD, 35% (n=8)


up tests used/
discussed
vascular cognitive with AD, 13% (n=3) with mixed

impairment, AD, and 9% (n=2) with unclassified
without dementia dementia. The incident dementia
group was marginally older (81.0
versus 78.7 years; P<0.07), had
more women (75.6 versus 54.4%;
P<0.03), and had lower 3MS
scores (74.2 versus 78.3; P<0.03)
than the no-‐dementia group. The
incident dementia group (n=34)
performed worse than the
nodementia group (n=42) on the
free (21.9 versus 26.1; P<0.02)
and cued (0.87 versus 0.95;
P<0.02) BCRT, suggesting that it is
the relative severity of memory
deficits that predicts progression
to dementia.

f) What are the differences between the tools used to assess VCI? (ie. Sensitivity, efficacy, etc)
Dong, 2012 Singapore International 239 Patients with Cognitive 6 MOCA, MMSE, 60 (25%) patients had Moderate-‐
ischaemic stroke and outcomes were months Neuropsychological severe VCI. The overall
Brief screening transient ischaemic dichotomised as Battery discriminant validity for detection
tests during acute attack were assessed either no-‐mild of moderate-‐severe cognitive
admission in with both MoCA and (impairment in <2 impairment was similar for MoCA
patients with mild MMSE within 14 days cognitive domains) (ROC 0.85 (95% CI 0.79 to 0.90)
stroke are after index stroke or moderate-‐ and MMSE (ROC 0.83 (95% CI 0.77
predictive of severe to 0.89)), p=0.96). Both MoCA
vascular cognitive (impairment in <3 (21/22) and MMSE (25/26) had
impairment 3-‐6 cognitive domains) similar discriminant indices at
vascular cognitive their optimal cutoff points;


months after stroke impairment. sensitivity 0.88 versus 0.88;
specificity 0.64 versus 0.67; 70%
versus 72% correctly classified.
Moreover, both tests had similar
discriminant indices in detecting
impaired cognitive domains.
Godefroy, France Observational 95 patients referred Acute poststroke NA MMSE, MoCA Using raw scores, MoCA was more
2011 for recent infarct or cognitive frequently impaired (P=0.0001)
hemorrhage. impairment than MMSE. MoCA showed good
In the Montreal sensitivity (sensitivity, 0.94) but
cognitive moderate specificity (specificity,
assessment 0.42; positive predictive value,
superior to the 0.77; negative predictive value,
mini-mental state 0.76), whereas an inverse profile
examination to was observed for MMSE
detect poststroke (sensitivity, 0.66; specificity, 0.97;
cognitive positive predictive value, 0.98;
impairment? negative predictive value, 0.58).
Adjusted scores with new cutoffs
(MMSEadj <24, MoCAadj <20)
provided good sensitivity and very
good specificity for both tests
(MMSEadj: sensitivity, 0.7,
specificity, 0.97, positive
predictive value, 0.98, negative
predictive value, 0.61; MoCAadj:
sensitivity, 0.67, specificity, 0.9,
positive predictive value, 0.93,
negative predictive value, 0.57).
On receiver operating
characteristic curve analysis, areas
under the curve of all scores were
>0.88.
Toglia, 2011 USA Observational 72 inpatients with To compare Median MMSE, MoCA, motor The MoCA classified more persons
stroke (mean age= Montreal Cognitive = FIM, motor relative as cognitively impaired than the
The mini-mental 70y with NIHSS=4 Assessment 8.5days functional efficiency MMSE (89% vs 63%, respectively;
state examination (MoCA) and Mini-‐ using a cutoff score of 27 on the
and MMSE= 25)


functional status
and improvement.
Dong, 2010 Singapore Observational 100 stable patients Cognitive and 4.2±2.4 MoCA, MMSE 57 patients with unimpaired
within 14 days of neurological days MMSE scores, 18 (32%) patients
The Montreal their index stroke measures had an impaired MoCA score. By
cognitive without significant poststroke comparison, only 2 out of the 41
assessment physical disability, (4.9%) patients with unimpaired
(MoCA) is aphasia, dysarthria, MoCA scores had impaired MMSE
superior to the active psychiatric scores. Moreover, MMSE domain
mini-mental state illness or pre-‐existing subtest scores could not
examination dementia differentiate between groups of
(MMSE) for the differing screening test results,
detection of whilst MoCA domain subtest
vascular cognitive scores (Visuospatial/Executive
impairment after Function, Attention and Recall)
acute stroke could.
Pendlebury, UK Observational 413 patients with Cognitive Up to 5 MMSE, MoCA (MMSE Although MMSE and MoCA scores
2010 stroke or TIA abnormalities after years <27 and MoCA <26 were highly correlated (r2=0.80,
stroke or TIA were taken to P<0.001), MMSE scores were
Underestimation indicate cognitive skewed toward higher values,
of cognitive impairment) whereas MoCA scores were
impairment by normally distributed: median and
mini-mental state interquartile range 28 (26 to 29)
examination and 23 (20 to 26), respectively.
versus the Two hundred ninety-‐one of 413
Montreal (70%) patients had MoCA <26 of
cognitive whom 162 had MMSE >27,
assessment in whereas only 5 patients had
patients with MoCA >26 and MMSE <27
transient (P<0.0001). In patients with
ischemic attack MMSE >27, MoCA <26 was
and stroke: a associated with higher Rankin


population-based scores (P=0.0003) and deficits in
study delayed recall, abstraction,
visuospatial/executive function,
and sustained attention.


2) Assessment Tools

Test Purpose Populatio Content Length Reliability Validity How to

n of Test obtain
the
tool?
Cambridg The CAMCOG The The CAMCOG consists of 20 to 30 No studies have Predictive Validity. 6 studies The
e is a CAMCOG 67 items. It is divided into minutes examined the internal examined the predictive validity of CAMCO
Cognition standardized can be 8 subscales: orientation, consistency of the the CAMCOG and reported that G can
Examinati assessment used with, language (comprehension CAMCOG in clients with the CAMCOG can be predicted by be
on instrument but is not and expression), memory stroke. No studies have age, the R-‐CAMCOG, the Mini-‐ obtaine
(CAMCOG) for diagnosis limited to (remote, recent and examined the reliability Mental State Examination and d by
and grading clients with learning), attention, praxis, of the CAMCOG in cognitive and emotional purchasi
of dementia stroke. calculation, abstraction clients with stroke. impairments. Additionally, the ng the
and perception. CAMCOG was an excellent entire
predictor of dementia 3 to 9 CAMDE
months post-‐stroke. However, the X from
CAMCOG was not able to predict the
QOL in clients with stroke and is Cambrid
not predicted by the Functional ge
Independence Measure. Known Universi
Groups: 2 studies using student t-‐ ty
test examined known groups Depart
validity of the CAMCOG and ment of
reported that the CAMCOG is able Psychiat
to distinguish between clients with ry
or without dementia as well as
aphasia severity in clients with
stroke.Convergent validity: 1 study


examined the convergent validity
of the CAMCOG in clients with
stroke and reported excellent
correlations between the
CAMCOG and the R-‐CAMCOG and
the Mini-‐Mental State
Examination shortly after and 1
year post-‐stroke. Correlations
between the CAMCOG and the
Functional Independence Measure
range from adequate after stroke
to poor at 1 year post-‐stroke. 1
study examined the convergent
validity of the CAMCOG-‐R and
reported excellent correlations
between the CAMCOG-‐R and the
Raven Test and the Weigl Test and
poor correlations between the
CAMCOG-‐R and the Geriatric
Depression Scale and the Barthel
Index using Pearson correlation.
Cognitive- The FIM was It has been There are 5 cognitive 30-‐45 In a review of 11 Content: The FIM was created http://w
Functiona also tested for items: comprehension, minutes studies, Ottenbacher et based on the results of a literature ww.va.g
l developed to use in expression, social to al., 1996 reported a review of published and ov/vdl/d
Independ offer a patients interaction, problem adminis mean inter-‐observer unpublished measures and expert ocumen
ence uniform with solving, and memory ter the reliability value of 0.95; panels and was then piloted in 11 ts/Clinic
Measure system of stroke, full test a median test-‐retest centers. The Delphi method was al/Func
(Cognitive measuremen traumatic (Motor reliability of 0.95 and a applied, using rehabilitation expert _Indep_
- FIM) t for disability brain and median equivalence opinion to establish the Meas/fi
based on the injury, Cognitiv reliability (across inclusiveness and appropriateness m_user
International spinal cord e) versions) of 0.92. of the items. _manua
Classification injury, Reliability was higher Criterion: Excellent correlations l.pdf)
of multiple for items in the motor with the Barthel Index ; Modified


Impairment, sclerosis, domain than for those Rankin Scale ; Disability Rating
Disabilities and elderly in the social/cognitive Scale. FIM scores found to predict
and individuals domain. Internal amount of home care required;
Handicaps. undergoing consistency: -‐ alpha of admission scores predict FIM
The level of a inpatient 0.93 – 0.95 reported at discharge scores; placement after
patient's rehabilitati admission vs. discharge discharge; functional gain; length
disability on and has (Dodds et al. 1993); of stay; depression, ability to
indicates the been used alpha = 0.88 to return to work following stroke or
burden of with 0.91(Hsueh et al. 2002); traumatic brain injury
caring for children as Hobart et al. (2001) Construct: FIM scores
them and young as 7 reported item-‐to-‐total discriminated between groups
items are years old. correlations ranging based on spinal cord injury and
scored on the from 0.53 to 0.87 for stroke severity, and the presence
basis of how FIM total, 0.60 for FIM of comorbid illness both at
much motor and 0.63 admission and discharge. It has
assistance is cognitive FIM – mean also been found to distinguish
required for inter-‐item correlations between patients with or without
the individual were 0.51 for FIM, 0.56 neglect and with or without
to carry out – 0.91 for motor FIM aphasia at both admission and
activities of and 0.72 – 0.80 for discharge.
daily living. cognitive FIM, alpha = Concurrent. The Cognition-‐FIM
0.95, 0.95 and 0.89 for was found to have an excellent
FIM, motor FIM and correlation with the DRS; an
cognitive FIM adequate correlation with the
respectively. Montebello Rehabilitation Factor
Score (MRFS) (efficacy); and a
poor correlation with the MRFS
(efficiency).
Convergent/Discriminant. The
total FIM was found to
demonstrate an excellent
correlation with the Office of
Population Censuses and Surveys


Disability Scales disability scores;
an adequate correlation with the
London Handicap Scale and the
Wechsler Adult Intelligence Test-‐
verbal IQ test; and a poor
correlation with the SF-‐36 Physical
and Mental components, and the
General Health Questionnaire. The
Cogntion-‐FIM was found to
demonstrate an excellent
correlation with the Mini-‐Mental
State Examination (MMSE); an
adequate correlation with the
Lowenstein Occupational Therapy
Cognitive Assessment (LOTCA),
Office of Population Censuses and
Surveys Disability scores, and the
revised Wechsler Adult
Intelligence Test-‐verbal IQ; and a
poor correlation with the London
Handicap Scale, SF-‐36 Physical and
Mental components, and the
General Health Questionnaire.
Ecological: The Cognition-‐FIM
demonstrated adequate
correlations with the OT-‐APST.
Frontal The FAB is a Tests: conceptualization, about Chinese FAB: The CFAB Chinese FAB: Internal consistency
Assessme brief tool that mental flexibility, 10 had low to good (alpha = 0.77), test-‐retest
nt Battery can be used programming, sensitivity minutes correlation with various reliability (rho = 0.89, p < 0.001),
at the to interference, inhibitory executive measures: and interrater reliability (rho =
bedside or in control, and MDRS I/P (r = 0.63, p < 0.85, p < 0.001) of CFAB were
a clinic environmental autonomy 0.001), number of good.
setting to category completed (r


assist in = 0.45, p < 0.001), and
discriminatin number of
g between perseverative errors (r
dementias = −0.37, p < 0.01) of
with a frontal WCST. Among the
dysexecutive executive measures,
phenotype only number of
and category completed
Dementia of had significant but
Alzheimer’s small contribution
Type (DAT). (6.5%, p = 0.001) to the
variance of CFAB. A
short version of CFAB
using three items
yielded higher overall
classification accuracy
(86.6%) than that of
CFAB full version
(80.6%) and MMSE
(77.6%). In another
test, which compared
the Chinese FAB to the
Mattis Dementia Rating
Scale
Initiation/Perseveration
subset: Both tests
showed comparably
good ability in Receiver
Operating
Characteristics curves
analysis (AUCMDRS I/P
= 0.887; AUC FAB =
0.854, p = .833) in


discriminating between
controls and patients
and correctly classified
over 78% of subjects.
Verbal fluency and
motor programming
contributed most to
the discriminating
power in the two tests.
Kettle The Kettle Clients The task of preparing two 5-‐20 No studies have Convergent: 1 study reported A
Test Test with stroke hot beverages is broken minutes examined the internal excellent correlation with the prelimin
measures who were down into 13 discrete consistency of the Functional Independence Measure ary
cognitive living steps that can be Kettle Test. No studies (FIM) Cognitive scale and version
skills in a independe evaluated. have examined the adequate correlation with the of the
functional ntly in the test-‐retest reliability of Mini-‐Mental Status Examination Kettle
context. community the Kettle Test. No (MMSE), Clock Drawing Test and Test
prior to studies have examined the Behavioural Inattention Test manual
stroke the intra-‐rater (BIT) Star Cancellation subtest. can be
reliability of the Kettle Known groups: The Kettle Test was obtaine
Test. 1 study examined able to discriminate clients with d from:
the inter-‐rater stroke from healthy controls. http://w
reliability of the Kettle ww.reh
Test and reported abmeas
excellent inter-‐rater ures.org
/Lists/R
ehabMe
asures/
DispFor
m.aspx?
ID=939
Mini- Screens for While The MMSE consists of 11 approx. Out of 9 studies Criterion: The MMSE can The


Mental cognitive originally simple questions or tasks 10 examining the internal discriminate between patients MMSE
State impairment used to that look at various minutes consistency of the with Alzheimer's Disease and can be
Exam detect functions including: MMSE, 3 reported poor frontotemporal dementia; can obtaine
(MMSE) dementia arithmetic, memory and internal consistency, 1 discriminate between patients d from
within a orientation. reported adequate with left-‐ and right-‐hemispheric the
psychiatric internal consistency, 2 stroke. Construct: Concurrent. current
setting, its reported poor to MMSE had a poor correlation with copyrigh
use is now excellent internal the Mattis Dementia Rating Scale; t owner,
widespread consistency, 2 reported poor to excellent correlations with Psychol
and is excellent internal the Wechsler Adult Intelligence ogical
available consistency, 1 reported Test; adequate correlation with Assessm
with an excellent internal the Functional Independence ent
attached consistency in patients Measure ; significant correlations Resourc
table that with Alzheimer's with the Montgomery Asberg es
enables Disease and poor Depression Rating Scale and the (PAR).
patient-‐ internal consistency in Zung Depression Scale. Predictive.
specific patients with cognitive MMSE scores found to be
norms. impairment. Out of 6 predictive of functional
studies examining the improvement in patients with
test-‐rest reliability of stroke following rehabilitation;
the MMSE, 2 studies discharge destination; developing
reported excellent test-‐ functional dependence at a 3-‐year
rest, 1 reported follow-‐up interval; ambulatory
adequate test-‐retest, 1 level; length of hospital stay such
reported adequate to that for patients with moderate
excellent test. retest, 1 dementia; death.
reported poor to Floor/Ceiling effects: Folstein,
adequate test-‐rest, 1 Folsten, and McHugh (1998)
reported poor test-‐ reported that the MMSE
retest. demonstrates marked ceiling
Out of 3 studies effects in younger intact
examining the inter-‐ individuals and marked floor
rater reliability of the effects in individuals with


MMSE, 1 reported moderate to severe cognitive
excellent inter-‐rater, 2 impairment.
reported adequate
inter-‐rater.
Montreal Measures Can be The items of the MoCA 5-‐10 Only 1 study has Criterion: Concurrent. Excellent The
Cognitive Mild used in examine attention and minutes examined the internal correlations with the Mini Mental MoCA is
Assessme Cognitive patients concentration, executive consistency of the State Examination (MMSE) have availabl
nt Tool Impairment with stroke functions, memory, MoCA and reported been reported. Construct: Known e for
(MoCA) and any language, excellent levels of groups. One study reported that free for
individual visuoconstructional skills, internal consistency. the MoCA can distinguish between educati
who is conceptual thinking, Only 1 study has patients with mild cognitive onal
experiencin calculations, and examined the test-‐ impairment and healthy controls. and
g memory orientation. retest reliability of the clinical
difficulties MoCA, and reported purpose
but scores excellent test-‐retest s at:
within the http://w
normal ww.moc
range on atest.or
the MMSE g.
NINDS- designed to Stroke The 60 minute assessment 60, 30, NA One group has tested the validity NA
CSN measure patients tests: executive/activation or 5 in ischemic stroke patients. 1. All
Harmoniz vascular function, visuospatial, minute three protocol scores are
ation VCI cognitive language/lexical retrieval, versions significantly lower than in patients
Neuropsy impairement memory and learning, and availabl than in matched controls (F
chology in stroke neuropsychiatric/depressiv e statistics range from 15.7 to 50.5;
Protocols patients e symptoms. The 30 all p values < .000; eta2 values
minute assessment tests a range from .14 to .31). 2. ROC
subset of the 60 minute analyses shows the 60M Executive
assessment including: subtest to be the most sensitive
semantic and phonemic and specific, followed by the
fluency, Digit Symbol-‐ Memory, Language, and Spatial


Coding and subtests (AUC values: .86, .75, .70,
the revised Hopkins Verbal .67, respectively). 3. WMH
Learning Test, in addition volumes show the most consistent
to the relationship between regional
CES-‐D and imaging and protocol scores, when
Neuropsychiatric compared to Stroke Volume and
Inventory. The 5 minute Brain Parenchymal Fraction
protocol consists of scores.
selected subtests from the
Montreal Cognitive
Assessment, including a 5-‐
word immediate and
delayed memory test, a 6-‐
item orientation task and a
1-‐letter phonemic fluency
test (the letter F).
Repeatabl brief NA The content of the RBANS 25 min NA in a stroke We present a rare case of stroke in The
e Battery neurocognitiv consists of neurocognitive population a 22-‐year-‐old psychiatric patient, RBANS
for the e battery test paradigms including who received neuropsychological is
Assessme with four tests for: immediate evaluations before and after distribut
nt of alternate memory, sustaining a right middle cerebral ed by
Neuropsy forms, visuopatial/constructional, artery (MCA) stroke. The RBANS Pearson
chological measuring language, attention, and demonstrated sensitivity to post-‐ , and
Status immediate delayed memory. stroke changes despite pre-‐stroke can be
(RBANS) and delayed cognitive impairments and a ordered
memory, complex psychiatric overlay, with online
attention, the Visuospatial/Constructional at
language, index being one of the most http://p
and sensitive indicators of right earsona
visuospatial hemisphere dysfunction. Line ssess.co
skills Orientation fell from normal to m/haiw
defective levels; these findings eb/cultu


were associated with decline in res/en-‐
related standard us/prod
neuropsychological measures. uctdetai
l.htm?pi
d=015-‐
8166-‐
000.


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Screening and Assessment of Vascular Cognitive Impairment

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Table of Contents

1) Vascular Cognitive Impairment and Dementia Evidence Tables .............................................................................................................................. 2

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a) What is the prevalence of Cognitive Impairment after stroke?

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(Hospital Anxiety >10), and mental and

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temporal lobe atrophy, female

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impairment three a complementary memory and other cognitive

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( p = 0.001) and vascular CIND ( p

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with infarctions in the left anterior

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Grey Literature and Narrative Reviews

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c) What tools are used to assess VCI?

Grey Literature and Narrative Reviews

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Diagnosis and management of vascular cognitive impairment

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Grey Literature and Narrative Reviews

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incorrectly to monitor patient

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The mean value of the Barthel

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rehabilitation for rehabilitation variance. Three years poststroke,

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infarct volume. We propose that

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provides valid Outcome Study intellectual functioning (R2 =

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vascular cognitive with AD, 13% (n=3) with mixed

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Test Purpose Populatio Content Length Reliability Validity How to

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