We all are familiar with the post-stroke inflammatory processes and network reorganization that occur within the first few months after stroke. Based on my observations, many patients are labeled unworthy of rehab after stroke and sent to longterm care institutions because of a MoCA test that was administered 3 days after stroke. Despite training and certification in administering these tests Inter-rater reliability is one of the major treats, especially when there is a cutoff to determine if a patient is or is not cognitively competent. However, such approaches expose clinicians to bias and misinterpretation. This approach tends to stratify patients based on their scores and makes it easier to follow the progression of disease or in some cases efficacy of treatments and therapeutics. When a patient is seen by a neurologist or a physiatrist it is easier to look at the chart and see a test score assigned to the patient by previous clinicians. Given the fact that in our modern medicine each patient is assessed and treated by multiple clinicians developing clinical tests deemed necessary. From executive function to memory, attention and motor planning, cognitive ability of a patient is a strong determinant of longterm outcome and prognosis. Whether hemorrhagic or ischemic, stroke is the main cause of vascular cognitive impairment (VCI). 4- MMSE and MoCA forms to download (PDF- English & French).3- Montreal Cognitive Assessment (MoCA): Sensitivity, Specificity and Predictive Values.2- Mini-Mental Status Examination (MMSE): Sensitivity, Specificity and Predictive Values.Here, we argue that in clinical settings, despite their usefulness, these tests do not provide helpful information and potentially create a preconceived notion about patients cognitive status if administered in the first few weeks of stroke onset. These test are administered mainly to detect Mild Cognitive Impairment (MCI) in older population, but in recent years their utility has increased in the realm of stroke care and research. The need for stratification and a common scale amongst clinicians to evaluate and rate patients cognitive status has led to development of clinical scales and tests such as Mini-Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA)-as well as a dozen more tests.
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