Abstract Introduction Early cognitive screening, although recommended, can be challenging in acute stroke settings. In patients with acute stroke, we aimed to evaluate (1) reasons and predictors of non-applicability of the Montreal Cognitive Assessment (MoCA) and (2) MoCA score performance, focusing on sex-related differences. Patients and methods We conducted a single-centre study on patients consecutively admitted to our stroke unit (June 2019–June 2023). Reasons for MoCA non-applicability and MoCA scores were compared between sexes. Univariate and multivariable analyses explored associations between MoCA applicability and sociodemographic/clinical characteristics. Results Out of 637 admitted patients (median age 78.8 years; 54.3% male; 81.2% ischemic stroke), 445 (69.8%) completed the MoCA (76.3% of males, 62.2% of females, P .001). Reasons for non-applicability were acute stroke-related in 63.5% of cases (mainly altered consciousness and aphasia), prestroke conditions-related in 22.9% and other (refusal/unreported) in 13.5%. Stroke-related reasons were more frequent in females (P =.002) and refusal in males (P =.005). Variables associated with MoCA non-applicability were: NIHSS on admission in both females (adjusted odds ratio adj.OR 1.25, 95% CI, 1.16–1.34) and males (adj.OR 1.24, 95% CI, 1.14–1.34); pre-stroke mRS in females (adj.OR 1.58, 95% CI, 1.15–2.17) and years of education and left-hemisphere lesion in males (adj.OR 0.91, 95% CI, 0.84–1.00 and adj.OR 2.38, 95% CI, 1.16–4.86, respectively). Among tested patients, females showed lower raw and adjusted MoCA scores (P .001 and P =.022, respectively). Conclusion Sex-specific factors influence feasibility and interpretation of early cognitive screening in the acute stroke phase: recognising these differences might guide future efforts towards more inclusive and individualised protocols.
Scopelliti et al. (Thu,) studied this question.