Please wait a minute...
3TMR Integrative Nursing  2019, Vol. 3 Issue (5): 166-172    DOI: 10.12032/TMRIN20190725
Introduction to cognitive assessment scales in screening for mild cognitive impairment after stroke: A review
Luo Yang1, Hong Guo1,*(), Yan-Ling Shen2, Li Li3, Hai-Yan Wang1, Shao-Hua Gong1, You-Hua Liu1, Xiao-Ping Yi1, Dan Zhao1, Hui Ju1
1School of Nursing, Beijing University of Chinese Medicine, Beijing, China
2Surgical Intensive Care Unit, China-Japan Friendship Hospital, Beijing, China
3Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
Download: HTML     PDF(445KB)
Export: BibTeX | EndNote (RIS)      


The cognitive assessment scales play an important role in the screening of mild cognitive impairment after stroke. This article reviews the application of cognitive assessment scales at home and abroad in the screening of mild cognitive impairment after stroke, in order to aid with the care of stroke.

Editor’s summary

The impact of cognitive impairment on stroke patients even exceeds the impact of limb dysfunction on daily living activities in stroke patients. Cognitive dysfunction is a common complication after stroke and is closely related to the poor prognosis of stroke.


Objective: In order to improve the quality of life of patients more effectively, this paper introduces the types and usages of scales for screening mild cognitive dysfunction after stroke and provides a basis for early identification of mild cognitive impairment. Methods: Read, analyze, summarize, and sort out relevant literature. Results: The mild cognitive impairment assessment scales are broadly divided into two categories: the comprehensive rating scales and the special assessment scales. There are 7 comprehensive assessment scales for the comprehensive rating scales, among which the Mini-mental State of Examination and the Montreal Cognitive Assessment Scale are the most widely used. The special assessment scales are mainly evaluated by the symptoms of cognitive dysfunction and can be divided into five types. Conclusion: Early diagnosis and intervention in patients with cognitive dysfunction will help improve the prognosis of patients. Each assessment scale has its advantages and limitations in both sensitivity and discrimination. Effective use of appropriate scales to diagnose cognitive dysfunction and to screen early, to prevent early, to treat early can effectively improve the quality of life of elderly patients.

Key wordsStroke      Mild cognitive dysfunction      Rating scale     
Published: 24 October 2019
Corresponding Authors: Guo Hong   
Cite this article:

Luo Yang, Hong Guo, Yan-Ling Shen, Li Li, Hai-Yan Wang, Shao-Hua Gong, You-Hua Liu, Xiao-Ping Yi, Dan Zhao, Hui Ju. Introduction to cognitive assessment scales in screening for mild cognitive impairment after stroke: A review. 3TMR Integrative Nursing, 2019, 3(5): 166-172. doi: 10.12032/TMRIN20190725

URL:     OR

1.   Sun XG, Wang YL, Zhang N, et al. Incidence and trends of stroke and its subtypes in Changsha, China from 2005 to 2011. J Clin Neurosci 2014, 21: 436-440.
2.   Iwashyna TJ, Ely EW, Smith DM, et al. Long-term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis. JAMA 2010, 304: 1787.
3.   Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004, 256: 183-194.
4.   Debette S, Beiser A, Decarli C, et al. Association of MRI Markers of Vascular Brain Injury with Incident Stroke, Mild Cognitive Impairment, Dementia, and Mortality. Stroke 2010, 41: 600-606.
5.   Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment-beyond controversies, towards a consensus: Report of the international working group on mild cognitive impairment. J Intern Med 2004, 256: 240-246.
6.   Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2010, 53: 695-699.
7.   Busse A, Bischkopf J, Riedel-Heller SG, et al. Subclassifications for mild cognitive impairment: prevalence and predictive validity. Psychol Med 2003, 33: 1029-1038.
8.   Lai JY. Progress in diagnosis and nursing of patients with mild cognitive impairment. Chin J Nurs 2013, 48: 1042-1045. (Chinese)
9.   Seshadri S, Beiser A, Kellyhayes M, et al. The Lifetime Risk of Stroke Estimates from the Framingham Study. Stroke 2006, 37: 345-350.
10.   Jin YP, Legge SD, Ostbye T, et al. The reciprocal risks of stroke and cognitive impairment in an elderly population. Alzheimers Dement 2006, 2: 171-178.
11.   Barba R, Martinez-Espinosa S, Rodriguez-Garcia E, et al. Poststroke Dementia: Clinical Features and Risk Factors. Stroke 2000, 31: 1494-1501.
12.   Hu XQ, Dou ZL, Wan GF, et al. The incidence of cognitive impairment and its influencing factors in stroke patients. Chin J Physical Med and Rehabilitation 2003, 25: 219-222. (Chinese)
13.   Hu XQ, Lan Y, Zheng HQ, et al. Analysis of related factors of cognitive dysfunction after initial stroke. Chin J Med 2009, 89: 2920-2923. (Chinese)
14.   Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment: Clinical characterization and outcome. Arch Neural 1999, 56: 303-308.
15.   Portet F, Ouset PJ, Viser PJ, et al. Mild cognitive impairment (MCI) in medical practice: a critical review of the concept and new diagnostic procedure. Report of the MCI Working Group of the European Consortium on Alzheimer’s Disease. J Neurol Neurosurg Psychiatry 2006, 77: 714-718.
16.   Jia JP, China Alzheimer's Disease Association (ADC). Guidelines for the diagnosis and treatment of dementia and cognitive impairment in China: diagnosis and treatment of mild cognitive impairment. Chin J Med 2010, 90: 2887-2892. (Chinese)
17.   Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12: 189-198.
18   Zhang MY. Psychiatric Handbook[M]. Shanghai: Shanghai Science and Technology Press 1999: 436-439. (Chinese)
19.   Mitchell AJ. A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. J Psychiatr Res 2009, 43: 411-431.
20.   Jang Y, Chern JS, Lin KC. Validity of the Loewenstein occupational therapy cognitive assessment in people with intellectual disabilities. Am J Occup Ther 2009, 63: 414-422.
21.   Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry 1982, 140: 566-572.
22.   Morris JC. The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology 1993, 43: 2412-2414.
23.   Kim KW, Lee DY, Jhoo JH, et al. Diagnostic accuracy of mini-mental status examination and revised hasegawa dementia scale for Alzheimer's disease. Dement Geriatr Cogn Disord 2005, 19: 324-330.
24.   Kim KW, Lee DY, Ahn SY, et al. Reliability and Validity of the Korean Version of Hasegawa Dementia Scale (HDS-K) as a Dementia Screening Instrument. J Korean Neuropsychiatr Association 2002, 41: 526-537.
25.   Llebaria G, Pagonabarraga J, Kulisevsky J, et al. Cut-off score of the Mattis Dementia Rating Scale for screening dementia in Parkinson's disease. Mov Disord 2010, 23: 1546-1550.
26.   Rascovsky K, Salmon DP, Hansen LA, et al. Distinct cognitive profiles and rates of decline on the Mattis Dementia Rating Scale in autopsy-confirmed frontotemporal dementia and Alzheimer’s disease. J Int Neuropsychol Soc 2008, 14: 373-383.
27.   Osmon DC, Smet IC, Winegarden B, et al. Neurobehavioral Cognitive Status Examination: Its use with unilateral stroke patients in a rehabilitation setting. Arch Phys Med Rehabil 1992, 73: 414-418.
28.   Junker BW, Sijtsma K. Cognitive assessment models with few assumptions, and connections with nonparametric item response theory. Appl Psychol Meas 2001, 25: 258-272.
29.   Listed N. Cognitive assessment of obsessive-compulsive disorder. Obsessive Compulsive Cognitions Working Group. Behav Res Ther 1997, 35: 667-681.
30.   Byrd DA, Touradji P, Tang MX, et al. Cancellation test performance in African American, Hispanic, and, White elderly. J Int Neuropsychol Soc 2004, 10: 401-411.
31.   Tombaugh TN. A comprehensive review of the Paced Auditory Serial Addition Test (PASAT). Arch Clin Neuropsychol 2006, 21: 0-76.
32.   Chen HC, Koh CL, Hsieh CL, et al. Test of Everyday Attention in patients with chronic stroke: test-retest reliability and practice effects. Brain Inj 2013, 27: 1148-1154.
33.   Cour PL, Gallagher K. Rivermead Behavioural Memory Test. Nord Psychol 1990, 42: 130-141.
34.   Yassuda MS, Flaks MK, Viola LF, et al. Psychometric characteristics of the Rivermead Behavioural Memory Test (RBMT) as an early detection instrument for dementia and mild cognitive impairment in Brazil. Int Psychogeriatr 2010, 22: 1003-1011.
35.   Moradi AR, Doost HTN, Taghavi MR, et al. Everyday Memory Deficits in Children and Adolescents with PTSD: Performance on the Rivermead Behavioural Memory Test. J Child Psychol Psychiatry 2010, 40: 357-361.
36.   Bouma JM, Mulder J. Rivermead Behavioural Memory Test (RBMT). Cancer 2012, 116: 1879-1886
37.   Moore PM, Baker GA. Validation of the Wechsler Memory Scale-Revised in a sample of people with intractable temporal lobe epilepsy. Epilepsia 2010, 37: 1215-1220.
38.   Hill EL. Executive dysfunction in autism. Trends Cogn Sci 2004, 8: 26-32.
39.   Kremen WS, Eisen SA, Tsuang MT, et al. Is the Wisconsin Card Sorting Test a useful neurocognitive endophenotype. Am J Med Genet B Neuropsychiatr Genet 2010, 144B: 403-406.
40.   Rozenblatt S. Behavioral Assessment of the Dysexecutive Syndrome. Springer New York, 2011.
41.   Zhang Y, Guo YL, Ma JT. Therapeutic effect of unilateral spatial neglect comprehensive rehabilitation training after stroke. Chin J Rehabilitation Med 2010, 25: 1195-1197. (Chinese)
42.   Li YM, Zhang Li, Lu YL, et al. Evaluation and rehabilitation nursing of unilateral neglect of patients with hemiplegia. Chin J Nurs 1998: 81-83. (Chinese)
43.   Wang L. Study on the visual spatial attention mechanism of stroke patients with hemianopia under the scope of guidance. Shanghai Jiaotong Univers 2012. (Chinese)
44.   Lin H. Effect of acupuncture combined with occupational therapy on comprehensive function after unilateral neglect of stroke. Chin J Rehabilitation Med 2011, 26: 25-28. (Chinese)
45.   Qi HY, Wu XF, Shao HJ, Yu JB, et al. Rehabilitation training Rehabilitation training and effect of attention disorder in patients with brain injury recovery period. Chin J Nurs 2011, 46: 1095-1098. (Chinese)
46.   Hartman-Maeir A, Katz N. Validity of the Behavioral Inattention Test (BIT): relationships with functional tasks. Am J Occup Ther 1995, 49: 507.
47.   Upton J. Beck Depression Inventory (BDI). J King Saud Univers - Sci 2003, 1: 453-486.
48.   Akbrai S, Lyden PD, Kamali M, et al. Correlations among impairment, daily activities and thinking operations after stroke. Neuro Rehabilitation 2013, 33: 153-160.
49.   Katz N, Averbuch S, Barhaim Erez A. Dynamic lowenstein occupational therapy cognitive assessment-geriatric version (DLOTCA-G): Assessing change in cognitive performance. Am J Occup Ther 2012, 66: 311.
50.   Jang Y, Chern JS, Lin KC. Validity of the Loewenstein occupational therapy cognitive assessment in people with intellectual disabilities. Am J Occup Ther 2009, 63: 414.
51.   Chen Han. Clinical observation of mild cognitive impairment. Jilin University, 2006. (Chinese)
52   52.Fang YH, Chen SJ, Zhou XX, et al. Investigation on the use status of six stroke cognitive rehabilitation assessment tools such as MoCA, MMSE and NCSE[J]. China Rehabilitation 2014, 29: 40-42. (Chinese)
[1] Luo Yang, You-Hua Liu, Dan Zhao, Hui Ju, Hai-Yan Wang, Shao-Hua Gong, Xiao-Ping Yi, Hong Guo. Traditional Chinese nursing care for post-stroke depression patients: A review[J]. 3TMR Integrative Nursing, 2019, 3(2): 56-60.