Deans' stroke musings: Feasibility of Cognitive Functions Screened With the Montreal Cognitive Assessment in Determining ADL Dependence Early After Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, August 29, 2018

Feasibility of Cognitive Functions Screened With the Montreal Cognitive Assessment in Determining ADL Dependence Early After Stroke

Will you stop with the assessments and recovery predictions and just deliver stroke rehab protocols. Survivors want 100% recovery. Why are you doing these wastes of time?
https://www.frontiersin.org/articles/10.3389/fneur.2018.00705/full?

Tamar Abzhandadze^1,2^*,

Lena Rafsten^1,2,

Åsa Lundgren-Nilsson^1,3 and

Katharina S. Sunnerhagen^1,3

¹Institute of Neuroscience and Physiology, Rehabilitation medicine, University of Gothenburg, Gothenburg, Sweden
²Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
³Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden

Objective: To investigate the feasibility of assessing cognitive function using the Montreal Cognitive Assessment (MoCA) given 36–48 h post stroke to explain dependence in activities of daily living (ADL).

Methods: This is a cross-sectional, exploratory study. Cognitive function and basic ADL were assessed with the MoCA and the Barthel Index (BI), respectively, within 36–48 h of admission. Neurological functions were assessed with the National Institute of Health Stroke Scale (NIHSS) upon admittance to the hospital. Binary logistic regression analyses were performed to assess the feasibility of the MoCA in explaining ADL dependence.

Results: Data were available for 550 patients (42% females, mean age 69 years). Moderate correlations (r_s > +0.30, p < 0.001) were found between the total score on the BI, MoCA, and visuospatial/executive functions. The regression analysis model including only MoCA as an independent variable had a high sensitivity for explaining ADL dependence. However, the model with independent variables of MoCA, NIHSS, and age had the best area under the curve value (0.74).

Conclusions: Cognitive functions assessed with the MoCA partly explain ADL dependence 36–48 h post stroke. Stroke-related neurological deficits and age should be additional considerations.

Introduction

Cognitive functions play an important role in patients' rehabilitation setting management (1) and safe discharge. Few studies have investigated the utility of assessing patients' cognitive functions during the early stages of stroke onset to explain activity-related outcomes. As even mild stroke can lead to cognitive impairments and influence patients' everyday functioning (2), it is important to identify these difficulties.

The Montreal Cognitive Assessment (MoCA) is a recommended tool for assessing cognitive functions in patients with acute stroke (3, 4). Good validity and reliability were reported for those with mild to moderate stroke (4). Studies performed on a subacute stroke population showed a positive association between impaired cognitive function assessed with the MoCA and a high level of global disability (5). Poor executive and memory functions were positively associated with dependence in activities of daily living (ADL) (6). However, explanatory factors for favorable ADL outcomes 3 to 12 month post stroke were stroke localization (7), younger age, less severity of neurological deficits, and good function in the upper extremities (7, 8).

The length of stay after the stroke has decreased substantially and particularly, the patients with very mild to mild neurological deficits, face very short hospital stay (9). The clinicians often have only couple of days to identify stroke related difficulties. Thus, there is increased need of very early assessments of cognitive functions. The MoCA and basic ADL with the Barthel Index (BI) are both commonly used instruments for this, in order to plan discharge. Whether cognitive functions assessed by the MoCA can explain patients' ADL ability at the early stage of stroke onset remains unknown. The aim of this study was therefore to investigate the feasibility of the MoCA to explain ADL dependence 36–48 h post stroke.