Highlights
- •Persons with stroke and Montreal Cognitive Assessment scores <20 at acute inpatient stroke rehabilitation admission are likely to have cognitive instrumental activities of daily living (C-IADL) deficits at discharge.
- •C-IADL should be screened in patients with stroke who have mild or no cognitive impairments on the Montreal Cognitive Assessment.
- •The Executive Function Performance Test bill paying task appears to be a good candidate for screening C-IADL in an inpatient rehabilitation setting.
- •Performance-based and questionnaire methods of assessing C-IADL provide different estimates of C-IADL.
Abstract
Objectives
To explore the relation between a computer adaptive functional cognitive questionnaire
and a performance-based measure of cognitive instrumental activities of daily living
(C-IADL) and to determine whether the Montreal Cognitive Assessment (MoCA) at admission
can identify those with C-IADL difficulties at discharge.
Design
Prospective cohort study.
Setting
Acute inpatient rehabilitation unit of an academic medical center.
Participants
Inpatients (N=148) with a diagnosis of stroke (mean age, 68y; median, 13d poststroke)
who had mild cognitive and neurological deficits.
Interventions
Not applicable.
Main Outcome Measures
Admission cognitive status was assessed by the MoCA. C-IADL at discharge was assessed
by the Executive Function Performance Test (EFPT) bill paying task and Activity Measure
of Post-Acute Care (AM-PAC) Applied Cognition scale.
Results
Greater cognitive impairment on the MoCA was associated with more assistance on the
EFPT bill paying task (ρ=−.63; P<.01) and AM-PAC Applied Cognition scale (ρ=-.43; P<.01). This relation was nonsignificant for higher MoCA scores and EFPT bill paying
task scores. The AM-PAC Applied Cognition scale and the EFPT bill paying task had
low agreement in classifying functional performance (Cohen's κ=.20). A receiver operating
characteristic curve identified optimal MoCA cutoff scores of 20 and 21 for classifying
EFPT bill paying task status and AM-PAC Applied Cognition scale status, respectively.
For values above 20 and 21, sensitivity increased whereas specificity decreased for
classifying functional deficits. Approximately one third of the participants demonstrated
C-IADL deficits on at least 1 C-IADL measure at discharge despite having a MoCA score
of ≥26 at admission.
Conclusions
Questionnaire and performance-based methods of assessment appear to yield different
estimates of C-IADL. Low MoCA scores (<20) are more likely to identify those with
C-IADL deficits on the EFPT bill paying task. The results suggest that C-IADL should
be assessed in those who have mild or no cognitive difficulties at admission.
Keywords
List of abbreviations:
AM-PAC (Activity Measure for Post-Acute Care), AUC (area under the curve), C-IADL (cognitive instrumental activities of daily living), EFPT (Executive Function Performance Test), IADL (instrumental activities of daily living), MoCA (Montreal Cognitive Assessment), NIHSS (National Institutes of Health Stroke Scale), ROC (receiver operating characteristic)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 03, 2017
Footnotes
Supported by the Peter Jay Sharp Foundation and in part by the Clinical and Translational Science Center, National Center for Advancing Translational Sciences (grant no. UL1-TR000457-06).
Clinical Trial Registration No.: NCT02876783.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
