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BACKGROUND AND PURPOSE: The impact of time-of-day on the cognitive performance of older patients with limited cognitive reserve after a transient ischemic attack (TIA) or stroke, and on short cognitive tests, such as the Montreal Cognitive Assessment (MoCA), is unknown. We retrospectively studied whether morning versus afternoon assessment might affect the classification of patients aged 70 or older as severe (SCI), mild (MCI), and no (NCI) cognitive impairment by the MoCA. METHODS: Morning (12 p.m. or earlier) versus afternoon (later than 12 p.m.) proportions of SCI (MoCA score <20), MCI (MoCA score 25-20) and NCI (MoCA score ≥26) were compared in a cohort of patients aged ≥70, attending a rapid-access TIA/stroke clinic. RESULTS: Of 278 patients, 113 (40.6%) were tested in the morning and 165 (59.4%) in the afternoon. The proportion with SCI was greater in the afternoon than in the morning (10.9 vs. 1.8%, respectively, p = 0.004), with no difference in age, education, diagnosis, disability, or vascular risk factors. CONCLUSIONS: Time-of-day appears to affect cognitive performance of older patients after they undergo TIA and minor stroke. If our cross-sectional findings are confirmed in cross-over studies with repeated testing, timing of assessments should be considered in clinical practice and in research studies.

Original publication




Journal article


Cerebrovasc Dis

Publication Date





290 - 293


Aging, Cerebrovascular disease, Circadian rhythm, Cognitive impairment, Age Factors, Aged, Aged, 80 and over, Circadian Rhythm, Cognition, Cognitive Dysfunction, Cross-Sectional Studies, Female, Humans, Ischemic Attack, Transient, Male, Mental Status and Dementia Tests, Predictive Value of Tests, Reproducibility of Results, Retrospective Studies, Risk Factors, Severity of Illness Index, Stroke, Time Factors