Abstracts were reviewed to include papers reporting on original research studies in which the MoCA was administered to patients diagnosed with various cerebrovascular conditions, including stroke, transient ischaemic attack (TIA), occlusion or stenosis of the internal carotid artery (ICA), silent cerebral infarct and/or leukoaraiosis. The main objectives of this review are to present and critique the evidence accrued in the ensuing 6 years concerning the validity and applications of the MoCA for assessing vascular cognitive impairment, and to make recommendations for future use of this tool in clinical practice and research.Ī PubMed search of all publications since 2005 was conducted using the following joint sets of terms: MoCA and stroke, MoCA and cerebrovascular disease, MoCA and small vessel disease, and Montreal Cognitive Assessment and stroke. In the absence of published data using the MoCA in a vascular disease population, this recommendation was based on evidence for the sensitivity of the MoCA for detecting mild cognitive impairment (MCI) in memory clinic patients, as well as on expert opinion regarding the cognitive domains most affected by vascular disease (content validity). In 2006, the National Institute of Neurological Disorders and the Stroke-Canadian Stroke Network recommended the Montreal Cognitive Assessment (MoCA) test, or some of its subtests, as an optimal brief protocol for the assessment of vascular cognitive impairment. Therefore, detection and monitoring of cognitive impairment is required in an increasing number of contexts to ensure adequate care of the patient with stroke or other vascular disorder. However, it is now well recognized that progressive declines in cognitive functioning may result from cerebrovascular disease even in the absence of a clinically detectable precipitating event. Traditionally, vascular cognitive impairment was understood uniquely as a condition resulting from a symptomatic ischaemic or haemorrhagic event, i.e. However, it compares favourably to the Mini Mental State Examination as a screening test that is sensitive to the milder forms of cognitive impairment that often accompany cerebrovascular disease.Ĭognitive impairment is a common consequence of stroke with a significant impact on response to rehabilitation, ability to return to work and ability to resume participation in society. Further research is needed to provide evidence for the validity of the MoCA in longitudinal studies. The MoCA correlates well with other measures of cognitive and functional abilities in patients with cerebrovascular disease, and may also predict future response to rehabilitation and long-term occupational outcome. Recent modifications of the MoCA have been developed for assessing patients with visual impairment or restricted mobility, which may reduce the impact of ‘untestability' on cognitive screening in the clinic or research context.

Evidence clearly supports the need to establish norms and cut-offs for the MoCA that are culturally appropriate and that are matched to the range of cognitive impairment that is present in the population being assessed. Nevertheless, content validity evidence suggests that the MoCA covers most of the domains that represent cognitive impairment in cerebrovascular disease, with mixed evidence for its preferential sensitivity to the type of cognitive impairment encountered in the context of vascular disease. Under-specification of the exclusion criteria applied and their impact make it difficult to assess the potential impact of sampling bias and loss to follow-up.

Reporting of the methods and results of such studies tended to fall short of the established reporting guidelines. A total of 30 papers employing the MoCA in the context of cerebrovascular disease were identified. This paper presents a critical review of the research literature evaluating the validity and utility of this test with the aim of informing future clinical and research practice. The Montreal Cognitive Assessment (MoCA) has been suggested as a brief screening test of vascular cognitive impairment. Recognition and monitoring of mild cognitive impairment is thus essential to good patient care. Cognitive impairment is common among patients with stroke or other cerebrovascular disease and influences long-term outcome, including occupational functioning.

Montreal Cognitive Assessment MOCA form