Electronic Thesis and Dissertation Repository


Master of Science


Epidemiology and Biostatistics


Drs. Mark Speechley

2nd Supervisor

Robert Teasell

Joint Supervisor


Objective. To identify the better of two commonly used screening tools for detecting probable cognitive impairment in stroke patients in a large regional rehabilitation hospital (ParkwoodHospital,London,Ontario). This was a validation study of the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MoCA), using the Cognistat, as the criterion or ‘gold standard’. It was hypothesized that the MoCA is a superior screening instrument to the MMSE for the detection of cognitive impairment in stroke patients.

Methods. The MMSE and the MoCA were administered by occupational therapists and the Cognistat was administered by the student investigator. A second Cognistat was administered by occupational therapists for the reliability sub-study. Age and side of stroke were abstracted in a chart review and patients were asked their level of education. ROC curves, sensitivity, specificity, positive and negative predictive values and positive likelihood ratios were analyzed. Intraclass correlation coefficients and kappa statistics were also calculated.

Results and Conclusion. The MMSE and the MoCA have relative strengths and weaknesses and neither emerged as a clearly superior tool however, the MoCA had a slightly better diagnostic accuracy than the MMSE. These results should be viewed with some caution due to the use of the Cognistat as the gold standard.