Association Between Two Measures of Cognitive Instrumental Activities of Daily Living and Their Relationship to The Montreal Cognitive Assessment In Persons with Stroke

Publication date: Available online 4 May 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Joan Toglia, Gulce Askin, Linda M. Gerber, Michael C. Taub, Andrea R. Mastrogiovanni, Michael W. O'Dell
ObjectiveTo explore the relationship between a computer adaptive functional cognitive questionnaire and a performance-based measure of cognitive instrumental activities of daily living of daily living (C-IADL). We also sought to determine whether the Montreal Cognitive Assessment (MoCA) at admission can identify those with C-IADL difficulties at discharge.DesignProspective Cohort StudySettingAcute inpatient rehabilitation unit of an academic medical center.ParticipantsOne hundred and forty-eight inpatients with a diagnosis of stroke; mean age of 68, median of 13 days post-stroke, mild cognitive and neurological deficits.InterventionN/A.Main Outcome MeasureAdmission cognitive status was assessed by the MoCA. Discharge C-IADL was assessed by the Executive Function Performance bill paying task (EFPT-b) and Activity Measure of Post-Acute Care Applied Cognition scale (AM-PAC-AC).ResultsGreater cognitive impairment on the MoCA was associated with more assistance on the EFPT-b (rs= -.63, p <.01) and AM-PAC-AC (rs=.43, p <.01). This relationship was nonsignificant for higher MoCA scores and the EFPT-b. The AM-PAC-AC and EFPT-b had low agreement in classifying functional performance (Cohen's kappa statistic = .20). A receiver operating characteristic curve identified optimal MoCA cutoff scores of 20/21 for classifying EFPT-b and AM-PAC-AC, respectively. For values above 20/21, sensitivity increased while specificity decreased for classifying functional deficits. Approximately 1/3 of participants demonstrated C-IADL deficiencies on at least one C-IADL measure at discharge despite having an admission MoCA score > 26.ConclusionsQuestionnaire 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-b. Results suggest C-IADL should be assessed, in those who have mild or no cognitive difficulties on admission.



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