Background
Cognitive testing after a vascular event e.g., stroke or heart failure, is integral to patient care. Early detection of cognitive impairment allows for timely interventions and rehabilitation planning. Current cognitive screening tools are lengthy and lacks of processing speed test.
Aim
This study aimed to develop the VasCog Screen test, a screening tool to detect CI in patients who had a stroke and with HF.
Method
427 patients who had a stroke and with HF were assessed using cognitive measures including Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and a formal neuropsychological battery. The short-MoCA was derived and combined with Symbol Digit Modalities Test (SDMT) to create the VasCog Screen. The discriminatory ability of different tests for CI was compared, establishing optimal cut-off points.
Results
Similar prevalence rates of CI were found in the stroke (n=187, 57.2%) and HF cohorts (n=44, 44.0%). Neuropsychological impairment in visuomotor speed was most prevalent (approximately 60%). The VasCog Screen was found to be superior to the MMSE (AUC: 0.82 vs 0.74, p<0.001), MoCA (AUC: 0.82 vs 0.76, p=0.02) and short-MoCA (AUC: 0.82 vs 0.76, p<0.001) in detecting CI.
Conclusion
The VasCog Screen has good sensitivity, specificity and classification accuracy, outperforming the MoCA, MMSE and other versions of the short-MoCA. It is suitable for routine cognitive screening in busy cardiovascular or stroke clinics, enabling the early detection of CI to facilitate appropriate interventions.