Additional Assessments

Additional Assessments

• Clinicians are encouraged to communicate with the interprofessional team about other resources and next steps in terms of additional assessments that could be provided. The Canadian Best Practice Guidelines 2012 makes reference to additional assessments in Table 7.2B: Summary of Select Screening Tools for Assessment of Vascular Cognitive Impairment in Stroke Patients: http://strokebestpractices.ca/wp-content/uploads/2013/03/Table7.2B-EN.pdf

• Other resources the clinician may refer to are:o Stroke Engine www.strokengine.ca/assess/assessmenttool-domains-en.htmlo Evidenced Based Review www.ebrsr.com

http://www.ebrsr.com/uploads/Module-12_cognition.pdf

MMSE Background

• MMSE was developed to identify dementia, delirium and cognitive changes over time

• A score of < 26 is an indication of cognitive deficit• It lacks sensitivity in detecting mild cognitive impairment and

early stages of dementia• Additional limitations of the MMSE in the stroke population:

• Ineffective in differentiating between focal and diffuse lesions• Only available in English • Performance is dependent on age and education factors• Insensitivity to right-sided lesions

Mackenzie, G., Gould, L., Ireland, S., LeBlanc, K. and Sahlas, D. (2011) “Detecting cognitive impairment in clients with mild stroke or transient ischemic attack attending a stroke prevention clinic”, Canadian Journal of Neuroscience Nursing, 33(1)

• 2011 study by MacKenzie et al. examined 20 patients diagnosed with likely TIA in a stroke prevention clinic

• All were screened for cognitive function• MMSE was administered upon admission to the study and the MoCA

was administered 2 weeks later - scores were then compared• Findings demonstrated that the MoCA was more sensitive than the

MMSE in determining the presence of mild cognitive impairments

Mackenzie, G., Gould, L., Ireland, S., LeBlanc, K. and Sahlas, D. (2011) “Detecting cognitive impairment in clients with mild stroke or transient ischemic attack attending a stroke prevention clinic”, Canadian Journal of Neuroscience Nursing, 33(1)

Comparison of MMSE and MoCA Scores

Instrument Participantsscoring in

Normal Range(> 26)

Mean Score

Standard Deviation

MMSE 90% 27.9 2.15

MoCA 45% 23.65 4.082 P=<0.05

MoCA and the MMSE

MoCA is a more sensitive screening tool than MMSE in detecting the presence of cognitive impairment in acute stroke population.

Possible Reasons for Increased Sensitivity:• Memory testing involves more words, fewer learning trials and

longer delayed recall?

• More numerous and demanding tasks to assess for visuospatial processing, executive functions, and language abilities.

• By adjusting the cut off scores it is sensitive to mild post Stroke cognitive impairment (MMSE & MOCA are similar)

Godefory et al, Stroke, 2011, (42)