Abstract Body: Introduction: Post-stroke cognitive decline (PSCD) is a common complication of strokes, and early assessment is crucial. However, outpatient cognitive assessment protocols are inconsistent, leading to missed diagnoses of PSCD. A potential solution is the XpressO application, introduced in 2023 by the creators of the Montreal Cognitive Assessment (MoCA). Because XpressO is self-paced, it can be completed by patients while waiting for an appointment and hence can assess cognition without impacting clinic workflow.

Hypothesis: This study aims to investigate the feasibility of using the XpressO online self-administered cognitive assessment and compare its ability to detect PSCD with the MoCA short form (MoCA-sf) at our out-patient stroke clinic.

Methods: Patients at the clinic with a history of ischemic or hemorrhagic strokes were included. We used <12 as the cutoff to determine low performance on the MOCA-sf. After their clinic visit, participants consented and completed a screening survey on stroke risk factors, followed by both the MoCA-sf and XpressO assessments. Completion times for both assessments were recorded, and results were analyzed using R Studio.

Results: We enrolled 32 patients and 32 completed the assessment. The results of this study found a moderate correlation between Xpresso and MOCA-sf (ρ = 0.645, p = 6.70e-05). When stratified by cognitive function, no significant correlation was observed between XpressO and higher MoCA-sf (≥12) scores (ρ = 0.128, p = 0.691). The average time to complete the assessment was 6.63 minutes for MOCA –sf and 6.28 minutes for Xpresso. This difference was not significant. However, when stratified by cognitive function, there was a significant difference in completion time between XpressO (4.43 minutes) and MoCA-sf (5.83 minutes).

Conclusion: The results suggest that XpressO is better at detecting severe cognitive decline but is less sensitive to milder impairments. Time to complete each test differed significantly only in patients with higher cognitive function, with XpressO being faster than MoCA in this group. XpressO’s lack of significant correlation with higher MoCA-sf scores makes it less suitable as a standalone tool for PSCD screening in outpatient stroke clinics. XpressO can be used to identify patients at risk for severe PSCD, but higher XpressO scores should not eliminate the possibility of PSCD in patients.