***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Determining cognitive dysfunctioning ( CDF ) after stroke is an important issue because it influences choices for management in terms of return to previous activities . Because previous research in subacute stroke has shown important variations in CDF rates , we aim ed to describe the frequency and neuropsychological profile of CDF in subacute stroke outside dementia . We used a large battery of tests to screen any potentially hidden CDF . Methods — Patients with Mini-Mental State Examination scores ≥23 were prospect ively and consecutively included 2 weeks after a first-ever ischemic brain infa rct . Stroke features were based on MRI . Four domains were evaluated : instrumental and executive functions , episodic memory , and working memory ( WM ) . Patients were scored using means and compared with education- and age-matched control subjects . Then we attributed Z-scores for each test and each domain . The most relevant cognitive tests characterizing CDF were determined using logistic regression . Results — Among 177 patients ( mean age , 50.6 years ) , 91.5 % failed in at least one cognitive domain . WM was the most impaired domain ( 87.6 % ) with executive functions ( 64.4 % ) , episodic memory ( 64.4 % ) , and instrumental functions ( 24.9 % ) being relatively preserved . CDF was associated with age , education , depression , neurological deficit , and leukoaraiosis in bivariate analysis . Using logistic regression , WM tests and age predicted CDF ( Modified Paced Auditorial Serial Addition Test : OR=0.96 CI=0.93 to 0.98 ; Owen-spatial-WM : OR=1.07 CI=1.02 to 1.12 ; age : OR=0.96 CI=0.93 to 0.98 ) . Conclusion — CDF appears to be almost constant , although underestimated , in subacute stroke . WM could reflect some hidden dysfunctioning , which may interfere with rehabilitation and return to work . Clinical routine may include WM tests in young patients with mild stroke Objectives To investigate the prognostic value of the neurocognitive status measured by screening instruments , the Montreal Cognitive Assessment ( MoCA ) and Mini-Mental State Examination ( MMSE ) , individually and in combination with the stroke severity scale , the National Institute of Health Stroke Scale ( NIHSS ) , obtained at the subacute stroke phase or the baseline ( ≤2 weeks ) , for functional outcome 3–6 months later . Design Prospect i ve observational study . Setting Tertiary stroke neurology service . Participants 400 patients with a recent ischaemic stroke or transient ischaemic attack ( TIA ) received NIHSS , MoCA and MMSE at baseline  and were followed up 3–6 months later . Primary outcome measures At 3–6 months following the index event , functional outcome was measured by the modified Rankin Scale ( mRS ) scores . Results Most patients ( 79.8 % ) had a mild ischaemic stroke and less disability ( median NIHSS=2 , median mRS=2 and median premorbid mRS=0 ) , while a minority of patients had TIA ( 20.3 % ) . Baseline NIHSS , MMSE and MoCA scores individually predicted mRS scores at 3–6 months , with NIHSS being the strongest predictor ( NIHSS : R2 change=0.043 , p<0.001 ) . Moreover , baseline MMSE scores had a small but statistically significant incremental predictive value to the baseline NIHSS for mRS scores at 3–6 months , while baseline MoCA scores did not ( MMSE : R2 changes=0.006 , p=0.03 ; MoCA : R2 changes=0.004 , p=0.083 ) . However , in patients with more severe stroke at baseline ( defined as NIHSS>2 ) , baseline MoCA and MMSE had a significant and moderately large incremental predictive value to the baseline NIHSS for mRS scores at 3–6 months ( MMSE : R2 changes=0.021 , p=0.010 ; MoCA : R2 changes=0.017 , p=0.021 ) . Conclusions Cognitive screening at the subacute stroke phase can predict functional outcome independently and improve the predictive value of stroke severity scores for functional outcome 3–6 months later , particularly in patients with more severe stroke Objective : To evaluate the prognostic value of domain-specific cognitive abilities in acute stroke with respect to long-term cognitive and functional outcome in addition to neurologic and demographic predictors . Methods : The authors evaluated 168 patients within the first 3 weeks after first-ever stroke . The prevalence of neuropsychological impairment was calculated vs 75 matched healthy controls . The authors also recorded demographic data , vascular risk factors , lesion characteristics , and clinical factors at admission . Independent predictor variables associated with long-term cognitive impairment ( assessed with a follow-up neuropsychological examination ) and functional impairment ( assessed with the modified Barthel Index and the Frenchay Activities Index ) were identified with stepwise multiple logistic regression . Areas under receiver operator characteristic curves were used to compare the predictive value of three models , i.e. , a st and ard medical model , a purely cognitive model , and a model consisting of both medical and cognitive predictors . Results : Thirty-one percent of patients showed long-term cognitive impairment . Basic and instrumental ADL disturbances remained present in 19 % and 24 % of patients . Domain-specific cognitive functioning predicted cognitive and functional outcome better than any other variable . Moreover , the prediction of instrumental ADL functioning improved when cognitive predictors were added to the st and ard medical model ( p < 0.05 ) . Impairments in abstract reasoning and executive functioning were independent predictors of long-term cognitive impairment . Inattention and perceptual disorders were more important in predicting long-term functional impairment . Conclusion : Domain-specific cognitive abilities in the early phase of stroke are excellent independent predictors of long-term cognitive and functional outcome While the Mini-Mental State Examination ( MMSE ) was originally developed to screen for dementia and delirium , many neurologists use this measure as a screening instrument for ' cognitive impairment ' in hospitalized stroke patients . However , the validity of the MMSE as such has never been evaluated in acute stroke . We administered the MMSE in addition to a neuropsychological examination covering six cognitive domains to 34 stroke patients ( mean interval between stroke and examination , 6.5+/-2.9 days ) and 34 healthy controls . The area under the receiver operating characteristic curve ( AUC ) was calculated in addition to the sensitivity and specificity for various cut-off points on the MMSE . Seventy percent of the patients were impaired in at least one cognitive domain . The accuracy of the MMSE  in detecting cognitive impairment was no better than chance ( AUC = 0.67 ; p = 0.13 ) . No optimum MMSE cut-off value could be identified . The MMSE is particularly insensitive to impairments in abstract reasoning , executive functioning , and visual perception/construction Objectives To determine the prognostic value of brief cognitive screening tests administered in the subacute stroke phase ( initial 2 weeks ) for the detection of significant cognitive impairment 3–6 months after stroke , the authors compared the  Montreal Cognitive Assessment ( MoCA )  and the  Mini-Mental State Examination ( MMSE ) . Methods Patients with ischaemic stroke and transient ischaemic attack were assessed with both MoCA and MMSE within 14 days after index stroke , followed by a formal neuropsychological evaluation of seven cognitive domains 3–6 months later . Cognitive outcomes were dichotomised as either no – mild ( impairment in ≤2 cognitive domains ) or moderate – severe ( impairment in ≥3 cognitive domains ) vascular cognitive impairment . Area under the receiver operating characteristic ( ROC ) curve analysis was used to compare discriminatory ability . Results 300 patients were recruited , of whom 239 received formal neuropsychological assessment 3–6 months after the stroke . 60 ( 25 % ) patients had moderate – severe VCI . The overall discriminant validity for detection of moderate – severe cognitive impairment was similar for MoCA ( ROC 0.85 ( 95 % CI 0.79 to 0.90 ) and MMSE ( ROC 0.83 ( 95 % CI 0.77 to 0.89 ) ) , p=0.96 ) . Both MoCA ( 21/22 ) and MMSE ( 25/26 ) had similar discriminant indices at their optimal cutoff points ; sensitivity 0.88 versus 0.88 ; specificity 0.64 versus 0.67 ; 70 % versus 72 % correctly classified . Moreover , both tests had similar discriminant indices in detecting impaired cognitive domains . Conclusions Brief screening tests during acute admission in patients with mild stroke are predictive of significant vascular cognitive impairment 3–6 months after stroke OBJECTIVE To assess whether , and to what extent , cognitive outcome relates to overall functional outcome among elderly stroke patients . DESIGN Nonconcurrent prospect i ve study . SETTING Geriatric rehabilitation division at a large , urban , academic , freest and ing hospital in Israel . PARTICIPANTS Three hundred thirty-six patients aged 60 years and older admitted consecutively for rehabilitation after first acute stroke . Inclusion criteria were met by 315 patients , who were included in the final analysis . Average age was 75.3 years . The stroke was right sided in 44.1 % . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The motor subscale of the FIM instrument assessed functional status . Absolute functional gain was determined by the FIM motor gain . Relative functional gain was calculated according to the Montebello Rehabilitation Factor Score . Cognitive status was assessed with the  Mini-Mental State Examination ( MMSE ) and the FIM cognitive subscale . RESULTS FIM scores increased significantly during rehabilitation , mainly due to improvement in motor functioning . A strong association was found between the cognitive scales ( r=.853 , P<.001 ) . Better rehabilitation outcomes were observed in patients with higher admission cognitive status , adjusting for the effect of age , sex , onset to admission interval , length of stay , and severity of stroke ( odds ratio = 2.0 ; 95 % confidence interval , 1.5 - 2.5 ) . CONCLUSIONS Impaired cognitive status at admission negatively affects the rehabilitation outcome of elderly stroke patients . The utility of routinely using a cognitive test for all patients before admission to rehabilitation , preferably the MMSE , is emphasized . The time , cost , and effort involved in performing such a test are negligible , and the potential benefits are considerable Background and aim : Social functioning is impaired in approximately two-thirds of stroke patients of vocational age , even several months after a first ever mild to moderate stroke . The known predictors of social functioning are initial stroke severity , anxiety and depression , and the Mini-Mental State Evaluation , suggesting that cognitive deficits contribute to post-stroke social dysfunctioning . The aim of this study was to evaluate whether cognitive domains correlated with social functioning and to determine the cognitive predictors of social dysfunctioning . Methods : 74 patients were prospect ively included 6 months after a first ever stroke . National Institutes of Health Stroke Scale ( NIHSS ) , modified Rankin scale , depression and anxiety were recorded . Social functioning was recorded using the Work and Social Adjustment Scale  ( WSAS ) . An extensive neuropsychological test battery explored general cognitive functioning , episodic memory , instrumental functions , executive functions and working memory . Univariate comparisons assessed the relationships between the neuropsychological tests and scores on the WSAS . Predicting factors for WSAS were determined using ordinal logistic regression . Results : 52 patients ( 70 % ; 95 % confidence interval 58 % to 80 % ) complained of significant perturbations in work and social functioning . In univariate comparisons , general cognitive functioning , memory , instrumental functions , executive functions and working memory significantly correlated with social functioning . Working memory was the most affected domain . With multivariate modelling , the NIHSS at admission , Hospital Anxiety Depression scale and Owen ’s Spatial Working Memory test were independent predictors of WSAS . Conclusions : All cognitive domains were associated with social functioning , working memory being the main cognitive determinant . Our results suggest that cognitive impairment impacts on social dysfunctioning , which is known to be a component of quality of life OBJECTIVES To assess the sensitivity and specificity of a screening battery for detecting cognitive impairment after stroke . DESIGN A r and omized controlled trial . METHODS Stroke patients were recruited from hospitals in three centres . Patients were screened for cognitive impairment on the Mini-Mental State Examination , the Sheffield Screening Test for Acquired Language Disorders and Raven 's Coloured Progressive Matrices and received a further battery of assessment s of cognitive function .  Sensitivity and specificity values were calculated for the three screening measures for overall conclusions regarding cognitive impairment reached from a comprehensive assessment . Receiver Operating Characteristic Curves were plotted . CONCLUSION The Mini-Mental State Examination was not a useful screen for memory problems or overall cognitive impairment after stroke . The Sheffield Screening Test for Acquired Language Disorders was an appropriate screen for language problems . The Raven 's Coloured Progressive Matrices was appropriate as a screen for perceptual problems and visual inattention but not for executive deficits OBJECTIVES To determine whether cognitive impairment affects access to , or quality of , rehabilitation services , and to examine the effects of functional outcomes in stroke patients . DESIGN Secondary analysis of prospect i ve cohort of stroke patients followed for 6 months after stroke . SETTING S Eleven large-volume US Department of Veterans Affairs hospitals nationwide . PARTICIPANTS Stroke patients ( N 
    Output:
    
Conclusion : None of the existing instruments fulfils all criteria .