Background: Patients who develop a stroke are at high risk for cognitive decline. The Montreal Cognitive Assessment (MOCA) is a validated tool for assessing cognitive function within this patient population prior to discharge. An important limitation of the MOCA is that often times there is no pre-morbid score for comparison. Despite this, consideration of occupational and cognitive therapy is important in this population because of the high risk for cognitive decline.
Methods: A total of 231 patients were treated on the stroke unit from December 2015 to June 2016, of these 149 patients were excluded due to activity intolerance, severe communication barriers, patient refusal, or cognitive deficits exceeding the limit of the screening tool. A retrospective chart review was conducted on the 82 patients and data on demographics, stroke risk factors, stroke type (ischemic, subarachnoid hemorrhage, or intracerebral hemorrhage), MOCA scores, and discharge disposition (home or acute/subacute rehabilitation) was extracted.
Results: Of the 82 patients in the study, 45 (55%) were male, with an average age of 54.9 years. Thirty-eight (46%) of these patients suffered hemorrhagic strokes. Average MOCA scores for hemorrhagic stroke patients who were either discharged home versus a rehab setting were similar when compared to the ischemic stroke population (20.1 and 18.2 versus 21.3 and 16.9, respectively). However, when subcategorized by stroke subtype, the subarachnoid hemorrhage population exhibited higher MOCA scores for those who were discharged home or to rehab versus the patients with ICH who were discharged home or to rehab (21.9 and 25.4 versus 19.1 and 13.6, respectively). Interestingly, the patients within the SAH cohort who were discharged to rehab had a higher MOCA average than those who were discharged home.
Conclusion: Many patients who suffer hemorrhagic strokes in this population are discharged home despite having a MOCA score below normal (<26). This may demonstrate residual cognitive deficits as a result of their disease process. Despite a patient’s ability to be functionally and physically able to return home, there is an identified need for addressing cognitive deficits in order to improve quality of life.