Cognitive assessments for the early diagnosis of dementia after stroke

Figures & data

Table 1 Cognition domain and function

Domain	Function related to domain
Attention	Focusing, sustain, selective, alternative, divided, shifting
Executive function Memory	Planning, organizing thoughts, inhibition, control Recall and recognition of visual and verbal information
Visuospatial ability Language	Visual search, drawing, concentration Expressive (Broca’s aphasia), receptive (Wernicke’s aphasia)

Figure 1 VCI spectrum and dementia.

Abbreviations: VCI, vascular cognitive impairment; MCI, mild cognitive impairment.

Figure 2 Flowchart of the literature search and selection process.

Table 2 Studies investigating the associations between stroke, cognitive impairments, and neuropsychological assessments within 3 months of stroke onset

Author (year)	Stroke characteristics (patients’ demography)	Risk factors	Cognitive impairment associated with PSD	Neuropsychological tests and cognitive decline evaluation
Tham et al^Citation32 (2002)	N=252 TIA (N=140 intact; age: 56.7 years; N=102 CIND, age: 65.1 years; N=10, D, age: 60.4 years) M/F =66/34	Hypertension, previous stroke, hyperlipidemia, diabetes, ischemic heart disease	Attention, language, verbal memory, visual memory, visuoconstruction, visuomotor speed	Tests: MMSE; WMS-R; CDT; WAIS; digital cancellation task; digital symbol modalities test; maze task; picture recall; mBNT; auditory detection test. Evaluation: subject classified by DSM-IV; MMSE score: 27.4 for intact, 23.5 for CI, 17.0 for D
Auchus et al^Citation37 (2002)	N=125 VaD; N=12 SSID, age: 69 years; M/F =58/41	Hypertension, myocardial infarction, diabetes mellitus	Attention, language (naming and verbal fluency), verbal memory (recall and recognition), visual memory (recall and recognition), and visuoconstruction	Tests: attention, language (naming and verbal fluency); verbal memory (recall and recognition); visual memory (recall and recognition); and visuoconstruction; together with the MMSE and screening for depression. Evaluation: VaD identified by NINDS–AIREN. Subject classified by DSM-III-R. MMSE score: 17.5 (range: 9–24)
Garrett et al^Citation41 (2004)	N=26 VaD, age: 77.1 years, M/F =66/34; N=18, VCIND, age: 78.4 years, M/F =56/29. Individual risk factors of CVD: age: 67.4 years, M/F =62/63; N=25, controls, age: 76.5 years, M/F =44/43	CVD	Visual memory, verbal fluency, verbal list-learning and memory abilities	Tests: TMT part A and B; CVLT; BNT; COWAT; MMSE; and CDR. Evaluation: subject classified by DSM-III; VaD identified by NINDS–AIREN. MMSE score: 28.2 for early control, 28.9 for individual at risk for CVD, 26.3 for VCIND, 26 for VaD
Mok^Citation42 (2004)	N=75 patients, age: 71 years, M/F =41.5/58.5; N=42 control, age: 69.6 years, M/F =47/48	Diabetes, previous stroke, hyperlipidemia, heart disease, smoking, alcohol use	Memory, thinking (decision making or answering questions), orientation (in time, place, or person), aphasia, and speech comprehension	Tests: CDR; MMSE; MDRS; IQCODE. Evaluation: daily living activity assessed by BI, IADL. MMSE score: 27.7 for control; 24.8 for patients
Graham et al^Citation40 (2004)	N=19 subcortical VaD, age: 71.2 years, M/F =73.6/26; N=19 AD, age: 68.9 years, M/F =47.3/52.6; N=19 controls, age: 68.1 years, M/F =47.3/52.6	CVD	Episodic and semantic memory, executive/attentional functioning, and visuospatial and perceptual skills	Tests: MMSE; ACE-R; CDR; CBI. Evaluation: VaD identified by NINDS–AIREN. MMSE score: 25.3 for VaD patients, 24.2 for AD patients
Sachdev et al^Citation39 (2004)	N=123 patients, age: 72 years, M/F =39.7/40.7; N=78 control, age: 70.6 years, M/F =43.9/44.9	Hypertension, diabetes, AF, CAD hyperlipidemia, smoking, alcohol use	Attention, global memory, verbal memory, visual memory, executive, abstraction, working memory, language, visuoconstruction	Tests: MMSE; WMS-R; BNT, WAIS-R; TMT part A and B; HAM-D; IQCODE. Evaluation: daily living activity assessed by ADL. MMSE score: 28.4 for control, 27.6 for patients
Firbank et al^Citation6 (2007)	N=79 patients (N=65 ND, age: 80.1 years, M/F =50/50; N=14 D, age: 80 years, M/F =64/35)	CVD	Medial temporal lobe atrophy associated with cognitive decline and brain atrophy, increasing the suggested role for AD	Tests: CAMCOG-R; MMSE; Sheffield language screening test. Evaluation: subject classified by DSM-IV. Daily living activity assessed by Bristol activity; stroke assessed by OCSP. MMSE score: 26 for ND, 25.1 for D
Mok et al^Citation33 (2008)	N=61 patients, age: 68.7 years, M/F =53/47; N=35 control, age: 68.9 years, M/F =37.1/62.9	Hypertension, diabetes mellitus, hyperlipidemia, heart disease, smoking, alcohol use	Verbal learning and memory, orientation, language, praxis and visuospatial functions, verbal fluency, and verbal, motor, and graphomotor programming	Test: MMSE. Evaluation: subject classified by CDR; stroke assessed by NIHSS. Daily living activity assessed by BI, MDRS, Lawton’s IADL index, AD assessed by ADAS-cog. MMSE score: 27.6 for control, 25.7 for patients
Stebbins et al^Citation38 (2008)	N=91 patients (N=51 NCI, age: 63.1 years, M/F =52/47; N=40 cognitive impairment, age: 67.4 years, M/F =47/52)	CVD	Orientation, attention, working memory, language, visuospatial, psychomotor, memory	Tests: IQCODE; MMSE; digital forward; WMS-R; digital backward; BNT; BDAE; animal naming; figure recognition test; Raven’s matrices; grooved pegs domain; symbol digital oral score; CLTR. Evaluation: subject classified by DSM-IV. MMSE score: 28.7 for NCI, 25.8 for CI
Jaillard et al^Citation36 (2009)	N=177 patients, age: 50.6, M/F =62.3/36.7; N=81 control, age: 51.9 years, M/F =58/42	Hypertension, diabetes mellitus, admission glycemia, low-density lipoprotein cholesterol, smoking, alcohol use, homocysteine	Short-term memory, episodic memory, executive function, working memory	Tests: MMSE; WAIS. Evaluation: stroke assessed by NIHSS. MMSE score: 28.5 for patients, 29.15 controls
Khedr et al^Citation34 (2009)	N=81 patients (N=17 D, age: 65.5±9.2 years, M/F =64/35; N=64 ND, age: 56.9±5.3 years, M/F =67/32	Hypertension, homocysteine level, smoking, CVD	Orientation, repetition of words, attention, calculation, recall of words, language, visual construction	Tests: IQCODE; MMSE; WMS-R; CASI. Evaluation: subject classified by DSM-IV. MMSE score at baseline: 25.58 for patients; 25.72 for control. MMSE score after 3 months: 22.77 for patients, 26.04 for control
Kandiah et al^Citation35 (2011)	N=97 NCI, age: 53 years, M/F =71/29; N=48 CI, age: 61 years, M/F =40/60	Hypertension, diabetes, hypercholesterolemia	Executive function, memory, visuospatial	Tests: MMSE; MoCA; FAB; IQCODE. Evaluation: subject classified by DSM-IV-TR, CDR. Stroke assessed by Rankin score. MMSE score: 29.1 for NCI, 26.4 for CI

Notes: M/F values were represented as percentages. Age is given as the average age in years.

Abbreviations: PSD, poststroke dementia; N, number of patients; TIA, transient ischemic attack; CIND, cognitive impairment no dementia; D, dementia; M, male; F, female; MMSE, Mini-Mental State Examination; WMS-R, Wechsler Memory Scale-Revised; CDT, Clock Diagnostic Test; WAIS, Wechsler Adult Intelligence Scale; mBNT, modified Boston Naming Test; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders Revised, fourth edition; CI, cognitively impaired; VaD, vascular dementia; SSID, strategic single infarct dementia; NINDS–AIREN, National Institute of Neurologic Disorders and Stroke and the Association International pour la Recherche et l’Enseignement en Neurosciences; DSM-III-R, Diagnostic and Statistical Manual of Mental Disorders, Revised, third edition; VCIND, vascular cognitive impairment no dementia; CVD, cerebrovascular disease; TMT, Trail Making Test; CVLT, California Verbal Learning Test; BNT, Boston Naming Test; COWAT, Control Oral World Association Test; CDR, Clinical Dementia Rating Scale; DSM-III, Diagnostic and Statistical Manual of Mental Disorders, third edition; MDRS, Mattis Dementia Rating Scale; IQCODE, Informant Questionnaire on Cognitive Decline of Elderly; NIHSS, National Institutes of Health Stroke Scale; BI, Barthel Index; IADL, instrumental activity of daily living; ACE-R, Addenbrooke’s Cognitive Examination; CBI, Cambridge Behavioral Inventory; AD, Alzheimer’s disease; AF, atrial fibrillation; CAD, coronary artery disease; WAIS-R, Wechsler Adult Intelligence Scale-Revised; Ham-D, Hamilton Depression Rating Scale; ADL, activity of daily living; ND, no dementia; CAMCOG-R, Cambridge Assessment of Mental Disorders in Elderly, Revised; OCSP, Oxfordshire Community Stroke Project; ADAS-cog, Alzheimer’s Disease Assessment Scale–Cognitive Subset; NCI, noncognitive impairment; BDAE, Boston Diagnostic Aphasia Examination; CLTR, Control Learning and Enhancing Recall; CASI, Cognitive Abilities Screening Instrument; MoCA, Montreal Cognitive Assessment; FAB, Frontal Assessment Battery; DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision.

Table 3 Studies presenting the limitations in poststroke memory assessment

Study/year	Stroke characteristics of patients	Neuropsychological tests
Cao et al^Citation44 (2007)	N=40 patients, age: 37.8 years, M/F =37/62; N=40 control, age: 38.8 years, M/F =40/60	MMSE, AVLT, DST, Token test, linguistic tasks, SVF, BNT, Cori’s block-tapping board, similarities, RPM, SDS
Yoshida et al^Citation45 (2011)	N=126 patients (N=62 control, age: 66.7±10.1 years, M/F =48/51.6; N=13 MCI, age: 62.7±12.3 years, M/F =46/53.8; N=65 AD, age: 74.1±7.8 years, M/F =26/73.8; N=24 FTD, age: 61.8±9.1 years, M/F =54/45; N=11 DLB, age: 75.5±5 years, M/F =27/72; N=28 VaD, age: 73.4±9.8 years, M/F =69/30)	ACE, MMSE, CDR
Bour et al^Citation43 (2010)	N=194 patients, age: 68.3 years, M/F =55.2/44.8	MMSE, MAAS, CAMCOG, GIT, SCWT, CST, AVLT
Dong et al^Citation47 (2010)	N=100 patients, age: 61.2±11.3 years, M/F =62/38	MMSE, MoCA, IQCODE
Pendlebury^Citation49 (2012)	N=91 ND patients, age: 73.4 years, M/F =56/44; N=39 MCI patients	MoCA, ACE-R, MMSE, TMT parts A and B, SDMT, BNT, Rey–Osterrieth complex figure, HVLT, GDS
Sikaroodi et al^Citation48 (2012)	N=50 patients, age: 51.8±13.18 years, M/F =32/68	MMSE, MoCA
Raimondi et al^Citation46 (2012)	N=83 patients (N=26 control, age: 73.23 years, M/F =50/50; N=25 AD, age: 77.64 years, M/F =40/60; N=32 VaD, age: 75.59 years, M/F =50/50)	CDR, BDI-II, MMSE, ACE-R

Notes: M/F values were represented as percentages. Age is given as the average age in years.

Abbreviations: N, number of patients; M, male; F, female; MMSE, Mini-Mental State Examination; AVLT, Auditory–Verbal Learning Test; DST, Digital Span Test; SVF, Semantic Verbal Fluency; BNT, Boston Naming Test; RPM, Raven’s Progressive Matrices; SDS, Self-Rating Depression Scale; MCI, mild cognitive impairment; AD, Alzheimer’s disease; FTD, frontotemporal dementia; DLB, dementia Lewy body; VaD, vascular dementia; ACE, Addenbrooke’s Cognitive Examination; CDR, Clinical Dementia Rating Scale; MAAS, Maastricht aging study; CAMCOG, Cambridge Assessment of Mental Disorders in Elderly; GIT, Groninger Intelligence Test; SCWT, Stroop Color Word Test; CST, Concept Shifting Test; MoCA, Montreal Cognitive Assessment; IQCODE, Informant Questionnaire on Cognitive Decline of Elderly; ND, no dementia; ACE-R, Addenbrooke’s Cognitive Examination, Revised; TMT, Trail Making Test; SDMT, Symbol Digit Modalities Test; HVLT, Hopkins Verbal Learning Test; GDS, Geriatric Depression Scale; BDI-II, Beck Depression Inventory II.

GorelickPBRisk factors for vascular dementia and Alzheimer diseaseStroke20043511 suppl 12620262215375299

 PubMed Web of Science ®Google Scholar

JaillardANaegeleBTrabucco-MiguelSLeBasJFHommelMHidden dysfunctioning in subacute strokeStroke20094072473247919461036

 PubMed Web of Science ®Google Scholar

GrahamNLEmeryTHodgesJRDistinctive cognitive profiles in Alzheimer’s disease and subcortical vascular dementiaJ Neurol Neurosurg Psychiatry2004751617114707310

 PubMed Web of Science ®Google Scholar

GarrettKDBrowndykeJNWhelihanWThe neuropsychological profile of vascular cognitive impairment – no dementia: comparisons to patients at risk for cerebrovascular disease and vascular dementiaArch Clin Neuropsychol200419674575715288328

 PubMed Web of Science ®Google Scholar

SachdevPSBrodatyHValenzuelaMJLorentzLMKoscheraAProgression of cognitive impairment in stroke patientsNeurology20046391618162315534245

 PubMed Web of Science ®Google Scholar

StebbinsGTNyenhuisDLWangCGray matter atrophy in patients with ischemic stroke with cognitive impairmentStroke200839378579318258824

 PubMed Web of Science ®Google Scholar

FirbankMJBurtonEJBarberRMedial temporal atrophy rather than white matter hyperintensities predict cognitive decline in stroke survivorsNeurobiol Aging200728111664166916934370

 PubMed Web of Science ®Google Scholar

ThamWAuchusAPThongMProgression of cognitive impairment after stroke: one year results from a longitudinal study of Singaporean stroke patientsJ Neurol Sci20022032044952

 Web of Science ®Google Scholar

AuchusAPChenCPSodagarSNThongMSngECSingle stroke dementia: insights from 12 cases in SingaporeJ Neurol Sci20022032048589

 Web of Science ®Google Scholar

KandiahNWiryasaputraLNarasimhaluKFrontal subcortical ischemia is crucial for post stroke cognitive impairmentJ Neurol Sci20113091–2929521807379

 PubMed Web of Science ®Google Scholar

MokVCWongALamWWBaumLWNgHKWongLA case-controlled study of cognitive progression in Chinese lacunar stroke patientsClin Neurol Neurosurg2008110764965618456396

 PubMed Web of Science ®Google Scholar

KhedrEMHamedSAEl-ShereefHKCognitive impairment after cerebrovascular stroke: relationship to vascular risk factorsNeuropsychiatr Dis Treat2009510311619557105

 PubMed Web of Science ®Google Scholar

BourARasquinSBoreasALimburgMVerheyFHow predictive is the MMSE for cognitive performance after stroke?J Neurol2010257463063720361295

 PubMed Web of Science ®Google Scholar

CaoMFerrariMPatellaRMarraCRasuraMNeuropsychological findings in young-adult stroke patientsArch Clin Neuropsychol200722213314217169527

 PubMed Web of Science ®Google Scholar

MokVCWongALamWWCognitive impairment and functional outcome after stroke associated with small vessel diseaseJ Neurol Neurosurg Psychiatry200475456056615026497

 PubMed Web of Science ®Google Scholar

RaimondiCGleichgerrchtERichlyPThe Spanish version of the Addenbrooke’s Cognitive Examination – Revised (ACE-R) in subcortical ischemic vascular dementiaJ Neurol Sci20123221–222823122959102

 PubMed Web of Science ®Google Scholar

SikaroodiHYadegariSMiriSRCognitive impairments in patients with cerebrovascular risk factors: a comparison of Mini Mental Status Exam and Montreal Cognitive AssessmentClin Neurol Neurosurg201311581276128023290422

 PubMed Web of Science ®Google Scholar

DongYSharmaVKChanBPThe Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute strokeJ Neurol Sci20102991–2151820889166

 PubMed Web of Science ®Google Scholar

YoshidaHTeradaSHondaHValidation of Addenbrooke’s cognitive examination for detecting early dementia in a Japanese populationPsychiatry Res20111851–221121420537725

 PubMed Web of Science ®Google Scholar