Rizwan Kalani, MD

Wong A, Nyenhuis D, Black SE, Law LSN, Lo ESK, Kwan PWL, et al. Montreal Cognitive Assessment 5-Minute Protocol Is a Brief, Valid, Reliable, and Feasible Cognitive Screen for Telephone Administration. Stroke. 2015

Vascular cognitive impairment (VCI) is being increasingly recognized, particularly in patients with stroke and TIA. The Montreal Cognitive Assessment (MoCA) is a validated and reliable screening tool for VCI, but requires a significant amount of time and the physical presence of the patient being examined. Wong et al constructed a 5-minute protocol, based on 4 subtests of the MoCA, and tested the validity and reliability of its administration by 

Patients were recruited from the longitudinal Stroke Registry Investigating Cognitive Decline (STRIDE) study. This enrolled patients with stroke or TIA from a major hospital in Hong Kong between 2009 and 2010. Those with pre-stroke dementia or moderate/severe dementia (defined by clinical dementia rating scale (CDR) ≥2) were excluded. At annual clinical assessment, patients in this study were assessed with the full MoCA, mini-mental state exam (MMSE), and cognitive dementia rating (CDR) scale. The MoCA 5-min protocol consisted of four tests evaluating five cognitive domains – attention, orientation, language, verbal learning and memory, and executive function – with a score range of 0-30. This was administered to patients by telephone one month after the clinic visit.

104 patients participated in this study, with assessment being an average of (±SD) 39.4 (±7.6) months after discharge for stroke/TIA. 49% of them had cognitive impairment. The MoCA 5-min protocol actually took ~5 minutes to complete by telephone whereas the full MoCA took ~12 minutes in clinic. The total scores between the two assessments were highly correlated (r=0.87, p<0.001). The score on the MoCA 5-min protocol was about 1.8 points higher on average than the MoCA. The cognitively impaired (CDR≥0.5) did more poorly on the MoCA and MoCA 5-min protocol (and all of its items scores) (p<0.001) compared to those with normal cognition. Importantly, those with executive domain impairment had significantly lower scores on the 5-min protocol compared to those without (15.6 vs 23.6, p=0.001). Thirty of the patients completed a repeat MoCA 5-min protocol about one month afterwards, with excellent reliability between the two assessments (intraclass coefficient 0.89).

This study demonstrates that a 5 minute telephone version of a cognitive screening tool can be useful, feasible, and reliable in stroke/TIA patients. Such testing could be very impactful for both research and clinical purposes. Future studies will have to evaluate this screening method in other populations and compare it to other brief cognitive evaluations that can be administered remotely by telephone and other methods.