WSO October 2023 – Issue 1 - 908

1178660
WSO
International Journal of StrokeWei et al.
Systematic Review
Which cutoff value of the Montreal
Cognitive Assessment should be used
for post-stroke cognitive impairment?
A systematic review and meta-analysis
on diagnostic test accuracy
Xiaoqin Wei1 , Yuxia Ma1 , Tingting Wu1, Yiyi Yang1,
Yue Yuan1 , Jiangxia Qin1, Zhaowen Bu1,2, Fanghong Yan1,
Ziyao Zhang3 and Lin Han1,2
Abstract
Background: Post-stroke cognitive impairment (PSCI) is one of the serious complications of stroke. The Montreal
Cognitive Assessment (MoCA), as a brief cognitive impairment screening tool, is widely used in stroke survivors. However,
some studies have suggested that the use of the universal cutoff value of 26 may be inappropriate for detecting
cognitive impairments in stroke settings.
Aim: We conducted this study to identify the optimal cutoff value of the MoCA in screening for PSCI.
Methods: PubMed, CINAHL, Embase, the Cochrane Library, and Web of Science were searched for eligible studies
until March 23, 2023. All studies were screened by two independent researchers. The quality of each article was evaluated
by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate mixed-effects model was used to pool
sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the summary receiver
operating characteristic curve.
Results: Twenty-four studies with a total of 4231 patients were included in this review. Despite the lack of evidence
of publication bias, a high degree of heterogeneity was observed. A meta-analysis revealed that a cutoff value of
21/22 yielded the best diagnostic accuracy. The optimal cutoff varied in different regions, stroke types, and stroke phases
as well.
Conclusion: The optimal cutoff of MoCA was 21/22 for stroke populations rather than the initially recommended
cutoff of 26. A revised (lower) cutoff should be considered for stroke survivors.
Keywords
Diagnostic accuracy, post-stroke cognitive impairment, Montreal Cognitive Assessment, cutoff
Received: 11 January 2023; accepted: 26 April 2023
International Journal of Stroke
2023, Vol. 18(8) 908 -916
© 2023 World Stroke Organization
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/17474930231178660
journals.sagepub.com/home/wso
https://doi.org/10.1177/17474930231178660
1Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
2Nursing Department, Gansu Provincial Hospital, Lanzhou, China
3Lanzhou University of Arts and Science, Lanzhou, China
Xiaoqin Wei and Yuxia Ma are co-first authors
Corresponding authors:
Ziyao Zhang, Lanzhou University of Arts and Science, Lanzhou, Gansu, China.
Email: 1451477396@qq.com
Lin Han, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.
Email: lzu-hanlin@hotmail.com
International Journal of Stroke, 18(8)
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WSO October 2023 – Issue 1

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