Underestimation of cognitive impairments by the Montreal Cognitive Assessment (MoCA) in an acute stroke unit population.

Background and purpose: The Montreal Cognitive Assessment (MoCA) is an increasingly popular clinical screening tool for detecting cognitive impairment in stroke, but fewstudies have directly compared performance on the MoCAwith neuropsychological assessment. Our retrospective study examined the extent towhich intact performance on the MoCA reflects intact cognition as determined by neuropsychological assessment. Methods: In this retrospective study, cognitive profiles for 136 acute stroke patients admitted to the Acute Stroke Unit who had available MoCA and neuropsychological assessment data were examined. Results: 22% of our patientswere deemed cognitively intact on theMoCA.Of these, 78%were found to be impaired (≤5%ile) on neuropsychological assessment in one or more cognitive domains. The most common impairments were in general intelligence, information processing speed and visual memory; three areas not assessed by the MoCA. In addition, a high proportion (up to 59%) of patients who scored the maximum points in one of the MoCA-specified domains were impaired on comparable neuropsychological assessment. Conclusions: Our findings suggest that although theMoCA may be a useful screening tool post-stroke in detecting gross impairments, neuropsychological assessment is still necessary for a comprehensive and reliable detection of domain-specific cognitive deficits, which can more reliably inform us for realistic goal setting and vocational advice vital for effective rehabilitation.