***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: 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 Background Cognitive impairment is common in patients with cerebral small vessel disease , but is not well detected using common cognitive screening tests which have been primarily devised for cortical dementias . We developed the  Brief Memory and Executive Test ( BMET ) ; a rapid screening measure sensitive to the impaired executive function and processing speed characteristic of small vessel disease ( SVD ) . To assess the BMET ’s validity for general use , we evaluated it when administered by non-psychologists in a multicentre study and collected control data to derive normative scores . Methods Two-hundred participants with SVD , defined as a clinical lacunar stroke and a corresponding lacunar infa rct on MRI , and 303 healthy controls aged between 40–90 years old were recruited . The BMET , as well as the Montreal Cognitive Assessment ( MoCA ) and Mini Mental State Examination ( MMSE )  , were performed . Overall , 55 SVD participants underwent repeat testing at 3 months to assess the BMET test-retest reliability . Results Administering the BMET took a mean ( SD ) of 12.9 ( 4.7 ) in cases and 9.5 ( 2.6 ) minutes in controls . Receiver Operator Curve analysis showed the BMET was a good predictor of cognitive impairment in SVD ( AUC = 0.94 ) and performed significantly better than both the MoCA ( AUC = 0.77 ) and the MMSE ( AUC = 0.70 ) . Using a cut-off score of 13 , the BMET had a sensitivity of 93 % and specificity of 76 % for detecting cognitive impairment in SVD . Conclusions The BMET is a brief and sensitive tool for the detection of cognitive impairment in patients with SVD BACKGROUND AND PURPOSE Cognitive impairment is common after stroke , but the prevalence and long-term significance of the diverse neuropsychological deficits on functional outcome are still not well known . The frequency and prognostic value of domain-specific cognitive impairments were investigated in a large cohort of ischaemic stroke patients . METHODS Consecutive patients ( n = 409 ) , aged 55 - 85 years , from the acute stroke unit of the Helsinki University Hospital , Finl and , were evaluated with extensive clinical and neuropsychological assessment s 3 months post-stroke . Impairments within nine cognitive domains were determined according to age-appropriate normative data from a r and om healthy population . Functional disability was evaluated with the modified Rankin scale ( mRS ) 3 and 15 months post-stroke . RESULTS In all , 83 % patients showed impairment in at least one cognitive domain , whereas 50 % patients were impaired in multiple ( ≥3 ) domains . In cases with excellent clinical recovery at 3 months ( mRS = 0 - 1 , no disability ) , the occurrence of any cognitive impairment was 71 % . Memory , visuoconstructional and executive functions were most commonly impaired . A substantially smaller proportion of patients scored below the conventional or more stringent cut-offs in the Mini-Mental State Examination ( MMSE ) . Domain-specific cognitive impairments were associated with functional dependence at 15 months regardless of stroke severity and other confounders . CONCLUSIONS Cognitive impairment as evaluated with a comprehensive neuropsychological assessment is prevalent in stroke survivors even with successful clinical recovery . Typically multiple domains and complex cognitive abilities are affected . MMSE is not sensitive in detecting these symptoms . Post-stroke cognitive impairment is strongly related to poor 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 Recent clinical research into aneurysmal subarachnoid hemorrhage ( aSAH ) has confirmed the long-term effect of cognitive dysfunction on functional outcomes . We hypothesized that early cognitive impairment was a marker of permanent brain injury and hence predicted long-term functional outcome . Hong Kong Chinese patients with aneurysmal subarachnoid hemorrhage were evaluated prospect ively by means of the  Montreal Cognitive Assessment ( MoCA )  in the subacute phase ( 2–4 weeks after aSAH ) and by  neuropsychological evaluation of functional outcomes  in the chronic phase ( 1 year after aSAH ) . This multi-center prospect i ve observational study is registered at Clinical Trials.gov of the US National Institutes of Health ( NCT01038193 ) . One hundred and eight patients completed both the subacute and chronic phase assessment s. Cognitive dysfunction in the subacute phase independently correlated with functional outcomes at 1 year , after adjusting for age , admission clinical condition , treatment modality , motor score , and mobility in the subacute phase , but the positive predictive values remained low . MoCA-assessed cognitive impairment in the subacute phase can not accurately predict functional outcomes at 1 year . Future study should focus on underst and ing the relative importance of different components of early cognitive impairment Objective Cognitive deficits are common after aneurysmal subarachnoid haemorrhage ( aSAH ) , and clinical evaluation is important for their management . Our hypothesis was that the  Montreal Cognitive Assessment ( MoCa ) is superior to the Mini-Mental State Examination ( MMSE ) in screening for cognitive domain deficit in aSAH patients . Methods We carried out a prospect i ve observational and diagnostic accuracy study on Hong Kong aSAH patients aged 21 to 75 years who had been admitted within 96 hours of ictus . The  domain-specific neuropsychological assessment battery , the MoCA and MMSE  were administered 2–4 weeks and 1 year after ictus . A cognitive domain deficit was defined as a cognitive domain z score < −1.65 ( below the fifth percentile ) . Cognitive impairment was defined as two or more cognitive domain deficits . The study is registered at Clinical Trials.gov of the US National Institutes of Health ( NCT01038193 ) . Results Both the  MoCA and the MMSE were successful in differentiating between patients with and without cognitive domain deficits and cognitive impairment at both assessment periods . At 1 year post-ictus , the MoCA produced higher area under the curve scores for cognitive impairment than the MMSE ( MoCA , 0.92 ; 95 % CI , 0.83 to 0.97 versus MMSE , 0.77 ; 95 % CI , 0.66 to 0.83 , p = 0.009 ) . Interpretation Cognitive domain deficits and cognitive impairment in patients with aSAH can be screened with the MoCA in both the subacute and chronic phases 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 Background and Purpose — The Mini-Mental State Examination ( MMSE ) is insensitive to mild cognitive impairment and executive function . The more recently developed Montreal Cognitive Assessment ( MoCA ) , an alternative , brief 30-point global cognitive screen , might pick up more cognitive abnormalities in patients with cerebrovascular disease . Methods — In a population -based study ( Oxford Vascular Study ) of transient ischemic attack and stroke , the MMSE and MoCA were administered to consecutive patients at 6-month or 5-year follow-up . Accepted cutoffs of MMSE < 27 and MoCA < 26 were taken to indicate cognitive impairment . Results — Of 493 patients , 413 ( 84 % ) were testable . Untestable patients were older ( 75.5 versus 69.9 years , P<0.001 ) and often had dysphasia ( 24 % ) or dementia ( 15 % ) . Although MMSE and MoCA scores were highly correlated ( r2=0 
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There was a tendency to find evidence of validity for criteria and to analyze the sensitivity/specificity of the instruments .
This review helps both research ers and clinicians to select the most appropriate screen for identifying cognitive impairment in adults post-stroke