Influência da escolaridade no rastreio cognitivo avaliado pelos instrumentos Addenbrooke's Cognitive Examination - Revised (ACE-R) e Montreal Cognitive Assessment (MoCA) em indivíduos no pós-Acidente Vascular Cerebral

Abstract

Stroke is a common disease and it has a great impact on world public health since it is the main cause of neurological disabilities and important motor and cognitive dysfunctions. After a stroke episode, the individuals often need rehabilitation and their ability to reach the goals imposed by this process depend, mainly, on their cognitive state. The usage of tracking tools sensitive to cognitive functions is extremely relevant to the evaluation process of these subjects. In this context, the Addenbrooke's Cognitive Examination - Revised (ACE-R) and the Montreal Cognitive Examination (MoCA) are inserted as useful tools in screening for cognitive impairment in clinical practice in patients with stroke. We also know the influence of social and political issues of our population, and thus the influence of non-unfavorable cognitive education through the ACE-R and MoCA tools in post-stroke contexts. This is a cross-sectional descriptive study with a quantitative approach. The study was performed in the houses of the participants where they were recruited for neurology service of the unit of stroke of the General Hospital of Fortaleza, Ceara. The sample was for convenience, totaling 32 patients, according to defined eligibility criteria. The data was Data were collected between January and May 2019. Data were analyzed using the statistical software package Statistical Package for Social Science (SPSS) version 21.0 for Windows. Descriptive and statistical analyzes were performed using the Chi-square association test, Spearman correlation ρ, comparison of means by Mann-Whitney U, effect size calculation (Cohen f²) and Fleiss kappa coefficient (κ). The results showed that schooling influences the outcome of a cognitive assessment depending to a greater or lesser extent on the instruments used. It is pointed to a strong effect of education on the total score of ACE-R and MMSE, considering the correlations established with the years of study and its effect. In turn, MoCA appears to be less influenced by respondent years of study, given the few significant correlations as well as the low effect size values. These results allow us to infer that ACE-R and MMSE are more suitable for contexts in which education is not a factor to be considered, as in cases where all participants have the same education. In turn, MoCA can be employed in contexts where the difference in years of study between participants is high.Therefore, the relevance of the choice of instruments for cognitive screening of patients after a stroke is concluded, considering the educational context for this assessment, and may even use two or more tests to complement the assessment. Such analysis will serve as the basis for a more effective rehabilitation, focused on the most evident cognitive dysfunctions in the study population.