Subgroups Defined by the Montreal Cognitive Assessment Differ in Functional Gain During Acute Inpatient Stroke Rehabilitation.

The study was observational, so it cannot show that a lower MoCA score caused less functional gain. Only patients who could complete the MoCA were analysed; 86 of 425 admitted patients were excluded, most often for impaired language. Compared with the analysed sample, excluded patients were younger, had higher stroke severity scores, and greater admission disability, so the findings may not apply to more severe or aphasic stroke. The study was done in one acute inpatient rehabilitation unit, and it did not look at function after discharge. Stroke severity was sometimes assessed from records, which may add measurement error. The moderately impaired group covered a wide score range, so it may contain different levels of impairment. The outcomes used, relative FIM gain and efficiency, tend to favor patients with higher admission FIM scores, so raw FIM change might have given different results. No neuroimaging was available to link MoCA groups to lesion characteristics.

The authors reported no conflicts of interest.

Do not conclude that a low MoCA score causes poor rehabilitation gain or that therapy should be reduced. The study was observational, and it did not test which rehabilitation modifications improve outcomes. It also excluded many patients with impaired language, so the findings do not apply to aphasic or more severely affected stroke patients.