Category: Stroke; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Measurement
Objective : To explore whether specific cognitive domains as measured by the Montreal Cognitive Assessment (MoCA) subscales contributed to functional gain above, and beyond that of admission motor Functional Independence Measure (mFIM) scores, within different MoCA severity groups (normal (25-30), mild (20-24), mod – severely impaired (<20).
Design : Observational. Collected MoCA scores and mFIM scores on initial admission and mFIM change scores (discharge mFIM – initial mFIM).
Setting : Urban inpatient rehabilitation unit
Participants (or Animals, Specimens, Cadavers) : 288 stroke patients, FIM Comprehension score 4 or above with initial MoCA score and mFIM admission and discharge scores. Normal subgroup n=52, mild n=101, impaired n=135. Mean MoCA per group: normal=26.67, mild=21.90, impaired=14.36. Education: normal=70% college or above; mild=53% college or above; impaired=43% college or above. Mean mFIM change: normal=21.42; mild=19.01; impaired=14.92.
Interventions : Interventions: Not applicable
Main Outcome Measure(s) : mFIM change
Stepwise regression analysis showed that the VisuoSpatial/Executive subscale significanty contributed to FIM gain in the impaired group (p<.001, adjusted R2 =.301) and was similar to results of the MoCA total score; while the attention subscale contributed to gain in the normal group (p=.010, adjusted R2 =.409). MoCA cognitive domains or total score did not uniquely contribute to functional gain in the mild group.
Analysis of MoCA subscales by cognitive domain shows that the Visuospatial/Executive subscale is a predictor of functional outcome for motor FIM change in the moderate-severe group. This can impact therapist clinical decision making with the cognitive therapy approach. Relationship of MoCA to functional gain in the mildly impaired group is less certain. This suggests that additional cognitive and functional assessments may be needed in the mild group to obtain more insight into factors contributing to functional outcome.
Ruchi Patel– senior occupational therapist, New York Presbyterian Weill Cornell, Brooklyn, New York
Joan Toglia– Professor and Dean, Mercy College, Dobbs Ferry, New York
Michael O'Dell– Professor, Vice-Chair of Clinical Services, Weill Cornell Medicine, New York, New York
Abhishek Jaywant– Assistant Professor, Weill Cornell Medicine, New York, New York