Oral Presentation Smart Strokes Annual Scientific Meeting 2025

Exploring the Sensitivity and Specificity of the Oxford Cognitive Screen-Australia and Montreal Cognitive Screen to detect Post-Stroke Cognitive Impairment (127720)

Michal Boneh 1 2 , Vincent Oxenham 3 4 , Alyssa Sher 3 , Kirsti Kankkunen 5 , Peter New 6 7 , Di Marsden 8 9 , Colette Sanctuary 8 , Luisa Hewitt 8 , Heather Francis 3 4 , Nele Demeyere 10 , Rene Stolwyk 1 2
  1. School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
  2. Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia
  3. School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
  4. Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
  5. Hampstead Rehabilitation Centre, Central Adelaide Local Health Network, Adelaide, SA, Australia
  6. Monash Health, Melbourne, VIC, Australia
  7. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  8. Hunter Stroke Service, Hunter New England Local Health District, Newcastle, NSW, Australia
  9. College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, SA, Australia
  10. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom

Introduction: Valid cognitive screening tools can facilitate early detection of impairments and access to rehabilitation. The aim of this study was to evaluate the sensitivity and specificity of the Australian Oxford Cognitive Screen (OCS-AU) and Montreal Cognitive Assessment (MoCA) to detect post-stroke cognitive impairment.

Methods: Stroke survivors (n=53) within 12 weeks of stroke were recruited from three states in Australia and administered the OCS-AU and MoCA in addition to a comprehensive cognitive assessment battery, which was used as the reference standard for sensitivity and specificity. Impairment was defined as failing (score below cut-off) any OCS-AU cognitive domain, scoring below the MoCA impairment cut-off (<26), or failing at least two domains on the comprehensive neuropsychological assessment.

Results: OCS-AU sensitivity was variable across domains, with Executive (0.12) and Memory (0.24) domains demonstrating relatively lower values and the Spatial Attention domain demonstrating higher sensitivity (0.92). OCS-AU specificity was consistently high across all domains (ranging from 0.80-0.96). The MoCA demonstrated higher sensitivity (0.81) but lower specificity (0.42), but was not domain specific.

Conclusions: The OCS-AU and MoCA exhibited different strengths and weaknesses. While the OCS-AU provides a cognitive profile of strengths and weakness and accurately identifies cognitively healthy individuals, stroke survivors with cognitive impairments such as memory and executive domains may be missed. In contrast, the MoCA may accurately detect those with cognitive impairment, which is important to facilitate referral for ongoing cognitive management, but it is more likely to incorrectly classify cognitively intact stroke survivors as impaired. Further research is required to confirm these findings in a larger cohort and across the recovery spectrum.

Relevance to clinical practice: This presentation will include a discussion on how clinicians can leverage and accommodate the strengths and weakness of these two leading cognitive screening tools to optimise cognitive assessment practices and ensure access to appropriate cognitive management and rehabilitation where appropriate.