Vascular cognitive impairment: most useful subtests of the Montreal Cognitive Assessment in minor stroke and transient ischemic attack

Dement Geriatr Cogn Disord. 2013;36(3-4):154-62. doi: 10.1159/000351674. Epub 2013 Jul 27.


Background/aims: Cognitive impairment is frequent in cerebrovascular disease but often remains undetected. The Montreal Cognitive Assessment (MoCA) has been proposed in this context. Our aim was to evaluate the MoCA and its subtests in cerebrovascular disease.

Methods: We assessed 386 consecutive patients with minor stroke (National Institutes of Health Stroke Score <4) or transient ischemic attack at 3 months. The MoCA and the modified Rankin Scale (mRS) were administered. Computed tomography (CT) scans were assessed for stroke and white matter changes. An unfavorable functional outcome was defined as mRS >1.

Results: The prevalence of cognitive impairment (cutoff of 26) was 55% using the MoCA and 13% using the MMSE. In a multivariate analysis, MoCA <26 was associated with the outcome (OR 3.00, CI 1.78-5.03), as were remote lacunar stroke on CT and white matter changes of at least moderate severity. Five subtests (5-word recall, word list generation, trail-making, abstract reasoning and cube copy) formed an optimal short MoCA with 6/10 or less showing a sensitivity of 91% and a specificity of 83%.

Conclusion: This study extends the utility of the MoCA to milder forms of cerebrovascular disease. The MoCA is associated with the 3-month functional outcome. Five subtests may constitute an optimal brief tool in vascular cognitive impairment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cerebrovascular Disorders / complications
  • Cerebrovascular Disorders / psychology
  • Cognition / physiology
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / etiology
  • Cognition Disorders / psychology*
  • Educational Status
  • Female
  • Humans
  • Ischemic Attack, Transient / classification
  • Ischemic Attack, Transient / complications
  • Ischemic Attack, Transient / psychology*
  • Male
  • Mental Recall
  • Mental Status Schedule
  • Neuroimaging
  • Neuropsychological Tests*
  • Prospective Studies
  • Recovery of Function
  • Socioeconomic Factors
  • Stroke / classification
  • Stroke / complications
  • Stroke / psychology*
  • Tomography, X-Ray Computed
  • Treatment Outcome