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Cognition in the first week after stroke: how does it relate to personal and instrumental activities of daily living at follow-up?

Published online by Cambridge University Press:  01 February 2021

Sarah Buys ,
Louise Gustafsson Open the ORCID record for Louise Gustafsson [Opens in a new window] ,
Hannah Gullo ,
Rohan Grimley ,
Mathew Summers  and
Alana Campbell
Sarah Buys
Affiliation:
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
Louise Gustafsson*
Affiliation:
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia School of Allied Health Sciences, Griffith University, Brisbane, Australia
Hannah Gullo
Affiliation:
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
Rohan Grimley
Affiliation:
Sunshine Coast University Hospital, Sunshine Coast, Australia
Mathew Summers
Affiliation:
School of Social Sciences, University of Sunshine Coast, Sunshine Coast, Australia
Alana Campbell
Affiliation:
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia Sunshine Coast University Hospital, Sunshine Coast, Australia
*
*Corresponding author. Email: [email protected]
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Abstract

Background:

The Montreal Cognitive Assessment (MoCA) is routinely used during the early assessment of people after stroke to indicate cognitive effects and inform clinical decision-making.

Aim:

The purpose of this study was to examine the relationship between cognition in the first week post-stroke and personal and instrumental activities of daily skills at 1 month and 3 months post-stroke.

Method:

A prospective cohort study consecutively recruited people admitted to the acute stroke ward. Acute cognitive status was measured using the MoCA within 1 week post-stroke onset. Functional outcomes were measured using the Functional Independence Measure (FIM) and the Australian Modified Lawton’s Instrumental Activities of Daily Living Scale (Lawton’s) at 1 month and 3 months post-stroke.

Results:

Fifty participants with predominantly mild stroke (n = 47) and mean age of 69.8 achieved a mean MoCA score of 23.1. Controlling for age, the MoCA was associated with the overall FIM score at 1 month (P = 0.02). It was nearing significance for the Lawton’s at 1 month (P = 0.06) but was not associated with either outcome at 3 months. A score of less than 23 on the MoCA was indicative of lower scores on both outcomes.

Conclusions:

A low MoCA score within 1 week of stroke may indicate need for support or rehabilitation due to early impacts on personal activities of daily living, but is not associated with poor functional outcomes at 3 months.

Keywords

self-carecommunity livingmild strokeoccupationfunctional
Type
Original Article
Information
Brain Impairment , Volume 23 , Issue 2 , September 2022 , pp. 185 - 195
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment

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Footnotes

Study performed at the Sunshine Coast University Hospital, Acute Stroke Unit (4A).

References

Abzhandadze, T., Rafsten, L., Nilsson, Å. S., Palstam, A., & Sunnerhagen, K. S. (2019). Very Early MoCA can predict functional dependence at 3 months after stroke: A longitudinal, cohort study. Frontiers in Neurology, 10, 1051. DOI: 10.3389/fneur.2019.01051.CrossRefGoogle ScholarPubMed
Adams, P. H., Davis, H. P., Leira, C. E., Chang, K.-C., Bendixen, W. R., Clarke, W. R., … Hansen, M. D. (1999). Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology, 53(1), 126–131. DOI: 10.1212/WNL.53.1.126.CrossRefGoogle Scholar
Al Banna, M., Abdulla Redha, N., Abdulla, F., Nair, B., & Donellan, C. (2015). Metacognitive function poststroke: A review of definition and assessment. Journal of Neurology Neurosurgery and Psychiatry, 87(2), 161–166. DOI: 10.1136/jnnp-2015-310305.Google ScholarPubMed
Al-Buhairi, A. R, Phillips, S. J., Llewellyn, G., & Jan, M. M. S. (1998). Prediction of infarct topography using the Oxfordshire Community Stroke Project classification of stroke subtypes. Journal of Stroke and Cerebrovascular Disease, 7(5), 339–343. DOI: 10.1016/S1052-3057(98)80052-9.CrossRefGoogle ScholarPubMed
Anderson, C. S., Taylor, B. V., Hankey, G. J., Stewart-Wynne, E. G., & Jamrozik, K. D. (1994). Validation of a clinical classification for subtypes of acute cerebral infarction. Journal of Neurology, Neurosurgery and Psychiatry, 57(10), 1173–1179. DOI: 10.1136/jnnp.57.10.1173.CrossRefGoogle ScholarPubMed
Australian Stroke Coalition Rehabilitation Working Group (2012). Assessment for rehabilitation: Pathway and decision-making tool. Melbourne, Australia. Retrieved from https://strokefoundation.org.au/en/Australian-Stroke-Coalition/Projects/Assessment-for-Rehabilitation-Pathway-and-Decision-Making-Tool Google Scholar
Beninato, M., Gill-Body, K., Salles, S., Stark, P., Black-Schaffer, R., & Stein, J. (2006). Determination of the Minimal Clinically Important Difference in the FIM Instrument in Patients With Stroke. Archives of Physical Medicine and Rehabilitation, 87(1), 32–39.CrossRefGoogle ScholarPubMed
Bocti, C., Legault, V., Leblanc, N., Berger, L., Nasreddine, Z, Beaulieu-Boire, I., … Boulanger, J.-M. (2013). Vascular cognitive impairment: Most useful subtests of the Montreal Cognitive Assessment in minor stroke and transient ischemic attack. Dementia and Geriatric Cognitive Disorders, 36(3–4), 154–162. DOI: 10.1159/000351674.CrossRefGoogle ScholarPubMed
Brott, P. T, Adams, P. H., Olinger, R. C., Marler, J. R., Barsan, W. G., Biller, J., … Walker, M. (1989). Measurements of acute cerebral infarction: A clinical examination scale. Stroke, 20(7), 864–870. DOI: 10.1161/01.STR.20.7.864.CrossRefGoogle ScholarPubMed
Cadilhac, D. A., Lannin, N. A., Kim, J., Anderson, C. S., Andrew, N., Kilkenny, M., … on behalf of the AuSCR Consortium (2017). The Australian Stroke Clinical Registry Annual Report 2016. Australia: The Florey Institute of Neuroscience and Mental Health.Google Scholar
Carson, N., Leach, L., Murphy, K. J. (2018). A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores. International Journal of Geriatric Psychiatry, 33(2), 379–388. DOI: 10.1002/gps.4756.CrossRefGoogle ScholarPubMed
Chan, E., Khan, S., Oliver, R., Gill, S. K., Werring, D. J., & Cipolotti, L. (2014). Underestimation of cognitive impairments by the Montreal Cognitive Assessment (MoCA) in an acute stroke unit population. Journal of the Neurological Sciences, 343(1–2), 176–179. DOI: 10.1016/j.jns.2014.05.005.CrossRefGoogle Scholar
Dong, Y., Slavin, M. J., Chan, B. P-L, Venketasubramanian, N., Sharma, V. K., Crawford, J. D., … Chen, C. L-H. (2013). Cognitive screening improves the predictive value of stroke severity scores for functional outcome 3–6 months after mild stroke and transient ischaemic attack: An observational study. British Medical Journal Open, 3(9), e003105. DOI: 10.1136/bmjopen-2013-003105.Google ScholarPubMed
Dromerick, A. W., Edwards, D. F., & Diringer, M. N. (2003). Sensitivity to changes in disability after stroke: A comparison of four scales useful in clinical trials. Journal of Rehabilitation Research and Development, 40(1), 1–8. DOI: 10.1682/JRRD.2003.01.0001.CrossRefGoogle ScholarPubMed
Green, J., Eagar, K., Owen, A., Gordon, R., & Quinsey, K. (2006). Towards a measure of function for home and community care services in Australia: Part 2 - Evaluation of the screening tool and assessment instruments. Australian Journal of Primary Health, 12(1), 82–90. DOI: 10.1071/PY06012.CrossRefGoogle Scholar
Harper, K. J., Riley, V., Jacques, A., MacDonald, K., & Spendier, N. (2019). Australian modified Lawton’s Instrumental Activities of Daily Living Scale contributes to diagnosing older adults with cognitive impairment. Australasian Journal of Ageing, 38(3), 199–205. DOI: 10.1111/ajag.12629.CrossRefGoogle ScholarPubMed
Horstmann, S., Rizos, T., Rauch, G., Arden, C., & Vetkamp, R. (2014). Feasibility of the Montreal Cognitive Assessment in acute stroke patients. European Journal of Neurology, 21(11), 1387–1393. DOI: 10.1111/ene.12505.CrossRefGoogle ScholarPubMed
Hsueh, I. P., Lin, J. H., Jeng, J. S., & Hsieh, C. L. (2002). Comparison of the psychometric characteristics of the Functional Independence Measure, 5 item Barthel Index, and 10 item Barthel Index in patients with stroke. Journal of Neurology, Neurosurgery and Psychiatry, 73(2), 188–190. DOI: 10.1136/jnnp.73.2.188 CrossRefGoogle ScholarPubMed
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9(3), 179–186. DOI: 10.1093/geront/9.3_Part_1.179.CrossRefGoogle ScholarPubMed
Linacre, J. M., Heinemann, A. W., Wright, B. D., Granger, C. V., & Hamilton, B. B. (1994). The structure and stability of the Functional Independence Measure. Archives of Physical Medicine and Rehabilitation, 75(2), 127–132. DOI: 10.5555/uri:pii:0003999394903840.CrossRefGoogle ScholarPubMed
Lyden, P., Brott, T., Tilley, B., Welch, K. M., Mascha, E. J., Levine, S., … Marler, J. (1994). Improved reliability of the NIH stroke scale using video training. Stroke, 25(11), 2220–2226. DOI: 10.1161/01.STR.25.11.2220.CrossRefGoogle ScholarPubMed
Mead, E. G., Wardlaw, J. M., Dennis, S. M., Lewis, S. C., & Warlow, C. P. (2000). Relationship between pattern of intracranial artery abnormalities on transcranial doppler and Oxfordshire Community Stroke Project clinical classification of ischemic stroke. Stroke, 31(3), 714–719. DOI: 10.1161/01.STR.31.3.714.CrossRefGoogle ScholarPubMed
Nasreddine, Z. S., Phillips, N. A, Bédirian, V., Charbonneau, S., Whiteheard, V., Collin, J., … Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of American Geriatric Society, 53(4), 695–699. DOI: 10.1111/j.1532-5415.2005.53221.x.CrossRefGoogle ScholarPubMed
Nezu, T., Hosomi, N., Lip, G. Y., Aoki, S., Shimomura, R., Maruyama, H., … Kobayashi, S. (2016). Temporal Trends in Stroke Severity and Prior Antithrombotic Use Among Acute Ischemic Stroke Patients in Japan. Circulation Journal, 80(9), 2033–2036. doi: 10.1253/circj.cj-16-0374 CrossRefGoogle ScholarPubMed
Nys, G. M. S., van Zandvoort, M. J. E., de Kort, P. L. M., Jansen, B. P.W., Kappelle, L. J., & de Haan, E. H. P.(2005). Restrictions of the Mini-Mental State Examination in acute stroke. Archives of Clinical Neuropsychology, 20(5), 623–629. doi: 10.1016/j.acn.2005.04.001.CrossRefGoogle ScholarPubMed
Ottenbacher, K. J., Hsu, Y., Granger, C. V., & Fiedler, R. C. (1996). The reliability of the Functional Independence Measure: A quantitative review. Archives of Physical Medicine and Rehabilitation, 77(12), 1226–1232. DOI: 10.1016/S0003-9993(96)90184-7.CrossRefGoogle ScholarPubMed
Pasi, M., Salvadori, E., Poggesi, A., Inzitari, D., & Pantoni, L. (2013). Factors predicting the Montreal Cognitive Assessment (MoCA) applicability and performances in a stroke unit. Journal of Neurology, 260(6), 1518–1526. DOI: 10.1007/s00415-012-6819-5.CrossRefGoogle ScholarPubMed
Rodríguez-Castro, E., López-Dequit, I., Santamaría-Cadavid, M., Arias-Rivas, S., Rodríguez-Yáñez, M., Pumar, J. M., … Iglesias-Rey, R. (2018). Trends in stroke outcomes in the last ten years in a European tertiary hospital. BMC Neurology, 18(1). doi: 10.1186/s12883-018-1164-7 CrossRefGoogle Scholar
Segal, M. E., & Schall, R. R. (1994). Determining functional/health status and its relation to disability in stroke survivors. Stroke, 25(12), 2391–2397.CrossRefGoogle ScholarPubMed
Sikkes, S. A., de Lange-de Klerk, E. S., Pijnenburg, Y. A., Scheltens, P., Uitdehaag, B. M. J. (2009). A systematic review of Instrumental Activities of Daily Living scales in dementia: Room for improvement. Journal of Neurology, Neurosurgery and Psychiatry, 80(1), 7–12. DOI: 10.1136/jnnp.2008.155838.CrossRefGoogle ScholarPubMed
Sivakumar, L., Kate, M., Jeerakathil, T., Camicioli, R., Buck, B., & Butcher, K. (2014). Serial Montreal Cognitive Assessments demonstrate reversible cognitive impairment in patients with acute transient ischemic attack and minor stroke. Stroke, 45(6), 1709–1715. DOI: 10.1161/STROKEAHA.114.004726.CrossRefGoogle ScholarPubMed
Suijker, J., Van Rijn, J., Ter Riet, M., Van Charante, G., De Rooij, E., & Buurman, P. (2017). Minimal important change and minimal detectable change in activities of daily living in community-living older people. The Journal of Nutrition, Health & Aging, 21(2), 165–172.CrossRefGoogle ScholarPubMed
Toglia, J., Askin, G., Gerber, L. M., Taub, M. C., Mastrogiovanni, A. R., & O’Dell, M. W. (2017). Association between 2 measures of cognitive instrumental activities of daily living and their relation to the Montreal Cognitive Assessment in persons with stroke. Archives Physical Medicine and Rehabilitation, 98(11), 2280–2287. DOI: 10.1016/j.apmr.2017.04.007.CrossRefGoogle Scholar
Toglia, J., Fitzgerald, K. A., O’Dell, M. W., Mastrogiovanni, A. R., & Lin, C. D. (2011). The Mini-Mental State Examination and Montreal Cognitive Assessment in persons with mild subacute stroke: Relationship to functional outcome. Archives of Physical Medicine and Rehabilitation, 92(5), 792–798. DOI: 10.1016/j.apmr.2010.12.034.CrossRefGoogle ScholarPubMed
van Der Wijst, E., Wright, J., & Steultjens, E. (2014). The suitability of the Montreal Cognitive Assessment as a screening tool to identify people with dysfunction in occupational performance after mild stroke. British Journal of Occupational Therapy, 77(10), 526–532. DOI: 10.4276/030802214X14122630932511 CrossRefGoogle Scholar
Wallace, D., Duncan, P., & Lai, S. (2002). Comparison of the responsiveness of the Barthel Index and the Motor Component of the Functional Independence Measure in stroke: The impact of using different methods for measuring responsiveness. Journal of Clinical Epidemiology, 55(9), 922–928.CrossRefGoogle ScholarPubMed
Wardlaw, J. M, Dennis, M., Lindley, R., Sellar, R. J., & Warlow, C. P. (1996). The validity of a simple clinical classification of acute ischaemic stroke. Journal of Neurology, 243(3), 274–279. DOI: 10.1007/BF00868526.CrossRefGoogle ScholarPubMed
Wong, G. K. C., Lam, S., Ngai, K., Wong, A., Mok, V., & Poon, W. S. (2012). Evaluation of cognitive impairment by the Montreal Cognitive Assessment in patients with aneurysmal subarachnoid haemorrhage: Prevalence, risk factors and correlations with 3 month outcomes. Journal of Neurology Neurosurgery and Psychiatry, 83(11), 1112–1117. DOI: 10.1136/jnnp-2012-302217.CrossRefGoogle ScholarPubMed
Zietemann, V., Georgakis, M. K., Dondaine, T., Müller, C., Mendyk, A. M., Kopczak, A., … Dichgans, M. (2018). Early MoCA predicts long-term cognitive and functional outcome and mortality after stroke. Neurology, 91(20), e1838–e1850. DOI: 10.1212/WNL.0000000000006506.CrossRefGoogle ScholarPubMed