scholarly journals Detecting Subtle Cognitive Impairment in Multiple Sclerosis with the Montreal Cognitive Assessment

2020 ◽  
Vol 47 (5) ◽  
pp. 620-626 ◽  
Author(s):  
Kim Charest ◽  
Alexandra Tremblay ◽  
Roxane Langlois ◽  
Élaine Roger ◽  
Pierre Duquette ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Deficits ◽  
Cognitive Assessment ◽  
Cognitive Status ◽  
Montreal Cognitive Assessment ◽  
Rapid Screening ◽  
Cognitive Complaints ◽  
Subjective Complaints ◽  
Subjective Cognitive Complaints

ABSTRACT:Background:Although cognitive deficits are frequent in multiple sclerosis (MS), screening for them with tools such as the Montreal Cognitive Assessment (MoCA) test is usually not performed unless there is a subjective complaint. The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is among the instruments most commonly used to assess self-reported subjective complaints in MS. Nonetheless, it does not always accurately reflect cognitive status; many patients with cognitive deficits thus fail to receive appropriate referral for detailed neuropsychological evaluation. The objective of this study was to examine the validity of the MoCA test to detect the presence of objective cognitive deficits among patients with MS without subjective complaints using the Minimal Assessment of Cognitive Function in MS (MACFIMS) as the gold standard.Methods:The sample included 98 patients who were recruited from a university hospital MS clinic. The MSNQ was used to select patients without subjective cognitive complaints who also completed the MACFIMS, MoCA test and MSQOL-54.Results:23.5% of patients without subjective cognitive complaints had evidence of objective cognitive impairment on the MACFIMS (z score < -1.5 on two or more tests). The MoCA had a sensitivity of 87% and a specificity of 68% for detecting objective cognitive impairment in this patient population using a cut-off score of 27.Conclusion:A significant proportion of patients without self-reported cognitive impairment do have evidence of cognitive deficits on more exhaustive cognitive assessment. The MoCA is a rapid screening test that could be used to target patients for whom a more detailed neuropsychological assessment would be recommended.

scholarly journals Psychometric Properties of the Persian Montreal Cognitive Assessment in Mild Cognitive Impairment and Alzheimer Disease

2021 ◽  
pp. 51-57
Author(s):  
Vahid Rashedi ◽  
Mahshid Foroughan ◽  
Negin Chehrehnegar
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Alzheimer Disease ◽  
Psychometric Properties ◽  
Cognitive Assessment ◽  
Screening Test ◽  
Cognitive Status ◽  
Montreal Cognitive Assessment ◽  
Cutoff Score ◽  
Persian Version

Introduction: The Montreal Cognitive Assessment (MoCA) is a cognitive screening test widely used in clinical practice and suited for the detection of Mild Cognitive Impairment (MCI). The aims were to evaluate the psychometric properties of the Persian MoCA as a screening test for mild cognitive dysfunction in Iranian older adults and to assess its accuracy as a screening test for MCI and mild Alzheimer disease (AD). Method: One hundred twenty elderly with a mean age of 73.52 ± 7.46 years participated in this study. Twenty-one subjects had mild AD (MMSE score ≤21), 40 had MCI, and 59 were cognitively healthy controls. All the participants were administered the Mini-Mental State Examination (MMSE) to evaluate their general cognitive status. Also, a battery of comprehensive neuropsychological assessments was administered. Results: The mean score on the Persian version of the MoCA and the MMSE were 19.32 and 25.62 for MCI and 13.71 and 22.14 for AD patients, respectively. Using an optimal cutoff score of 22 the MoCA test detected 86% of MCI subjects, whereas the MMSE with a cutoff score of 26 detected 72% of MCI subjects. In AD patients with a cutoff score of 20, the MoCA had a sensitivity of 94% whereas the MMSE detected 61%. The specificity of the MoCA was 70% and 90% for MCI and AD, respectively. Discussion: The results of this study show that the Persian version of the MoCA is a reliable screening tool for detection of MCI and early stage AD. The MoCA is more sensitive than the MMSE in screening for cognitive impairment, proving it to be superior to MMSE in detecting MCI and mild AD.

scholarly journals Screening of Cognitive Impairment in Patients with Multiple Sclerosis: A Cross-Sectional Study in Georgia

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Nazibrola Botchorishvili ◽  
Nino Shiukashvili ◽  
Nina Mikeladze ◽  
Ann Dzagnidze ◽  
Nino Mikava ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Negative Impact ◽  
Cognitive Status ◽  
Screening Tools ◽  
Cognitive Test ◽  
Favorable Effect ◽  
Common Symptom ◽  
Disability Status

Cognitive impairment (CI) is a common symptom of multiple sclerosis (MS), with a significant negative impact on the occupational and social functioning of patients. This study aimed to estimate the prevalence and characteristics of CI among MS patients in Georgia. Sixty-eight patients with MS attending a neurology outpatient clinic in Tbilisi, Georgia, were enrolled in the study. Cognitive status was evaluated using two screening tools: the Brief International Cognitive Assessment for MS and the Montreal Cognitive Assessment. The overall prevalence of CI in our MS patients was 47%. We found negative associations between cognitive test results and patients’ age, disability status, and depression. Lower education, higher scores on the Expanded Disability Status Scale, and the progressive course of MS were the main predictors of CI in the logistic regression analysis. This is the first study in Georgia to evaluate CI in patients with MS. The prevalence of CI in our study was comparable with those reported in other countries; however, we found greater impairment of the executive system compared to other cognitive domains. In our study, patients who were on continuous DMT showed significantly better performance on the cognitive tests used, indicating possible favorable effect of immunomodulatory drugs on cognition.

Changes in visual memory in mild cognitive impairment: a longitudinal study with CANTAB

2020 ◽  
pp. 1-11 ◽  
Author(s):  
María Campos-Magdaleno ◽  
David Leiva ◽  
Arturo X. Pereiro ◽  
Cristina Lojo-Seoane ◽  
Sabela C. Mallo ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Visual Memory ◽  
Regression Models ◽  
Cognitive Status ◽  
Multinomial Regression ◽  
Cognitive Complaints ◽  
Spatial Span ◽  
Evaluation Time ◽  
Subjective Cognitive Complaints

Abstract Background Mild cognitive impairment (MCI), as a stage in the cognitive continuum between normal ageing and dementia, is mainly characterized by memory impairment. The aims of this study were to examine CANTAB measures of temporal changes of visual memory in MCI and to evaluate the usefulness of the baseline scores for predicting changes in cognitive status. Methods The study included 201 participants aged over 50 years with subjective cognitive complaints. Visual memory was assessed with four CANTAB tests [paired associates learning (PAL), delayed matching to sample (DMS), pattern recognition memory (PRM) and spatial span (SSP)] administered at baseline and on two further occasions, with a follow-up interval of 18–24 months. Participants were divided into three groups according to the change in their cognitive status: participants with subjective cognitive complaints who remained stable, MCI participants who remained stable (MCI-Stable) and MCI participants whose cognitive deterioration continued (MCI-Worsened). Linear mixed models were used to model longitudinal changes, with evaluation time as a fixed variable, and multinomial regression models were used to predict changes in cognitive status. Results Isolated significant effects were obtained for age and group with all CANTAB tests used. Interactions between evaluation time and group were identified in the PAL and DMS tests, indicating different temporal patterns depending on the changes in cognitive status. Regression models also indicated that CANTAB scores were good predictors of changes in cognitive status. Conclusions Decline in visual memory measured by PAL and DMS tests can successfully distinguish different types of MCI, and considered together PAL, DMS, PRM and SSP can predict changes in cognitive status.

scholarly journals Comparative assessment of Montreal Cognitive Assessment (MOCA) and Minimental State Examination (MMSE) in apolipoprotein E (APOE) ɛ4 allele carriers in epilepsy

2016 ◽  
Vol 03 (01) ◽  
pp. 007-011 ◽  
Author(s):  
Amirthalingam Palanisamy ◽  
Natham Rajendran ◽  
Mukundhu Narmadha ◽  
Ruckmani Ganesvaran
Keyword(s):  
Cognitive Impairment ◽  
Apolipoprotein E ◽  
Cognitive Assessment ◽  
High Sensitivity ◽  
Educational Status ◽  
Cognitive Status ◽  
Montreal Cognitive Assessment ◽  
Normal Cognitive Function ◽  
E4 Allele ◽  
State Examination

AbstractBackground/Aim Mini mental state examination (MMSE) is a widely accepted tool till date to investigate cognitive status; however, its sensitivity is questioned by few studies. Alternately, Montreal cognitive assessment (MOCA) is considered more effective with high sensitivity to assess cognitive status than MMSE. The usefulness of MOCA is well established in assessing cognitive status in patients in various disorders. Apolipoprotein E (APOE) ɛ4 allele is identified as one of the risk factors associated with cognitive impairment on MMSE; however, the usefulness of MOCA on the association between APOE ɛ4 allele and cognitive impairment is not clearly established and hence the present study.Methods This prospective study recruited 123 subjects diagnosed as tonic-clonic seizures in the study site during the study period.Results Gender and educational status showed normal cognitive function on MMSE but showed cognitive impairment on MOCA. Among epilepsy patients, all APOE ɛ4 carriers showed mild to severe cognitive impairment on MOCA but differences in cognitive status were observed in this population as well as in APOE ɛ4 non-carriers on MMSE.Conclusion Thus, the present study demonstrates the sensitivity of MOCA over MMSE in detecting cognitive impairment in epilepsy.

scholarly journals Subjective Cognitive Complaints in Newly-Diagnosed Parkinson’s Disease With and Without Mild Cognitive Impairment

2021 ◽  
Vol 15 ◽  
Author(s):  
Chenxi Pan ◽  
Jingru Ren ◽  
Ping Hua ◽  
Lei Yan ◽  
Miao Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Logistic Regression ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Status ◽  
Newly Diagnosed ◽  
Cognitive Complaints ◽  
Subjective Cognitive Complaints

Background: Subjective cognitive complaints (SCCs) and mild cognitive impairment (MCI) are common among patients with Parkinson’s disease (PD). However, the relationship between SCCs and MCI is not well understood. Herein, we aimed to investigate whether there are any differences in the prevalence and risk factors of SCCs between early PD patients with and without MCI.Methods: Overall, 108 newly diagnosed, untreated PD patients underwent comprehensive neuropsychological assessments. PD patients with mild cognitive impairment (PD-MCI) were diagnosed according to the MCI level II criteria. Furthermore, SCCs were measured with the Cognitive Complaints Interview (CCI). Logistic regression analysis, after adjusting for confounding variable, was performed in order to investigate risk factors of SCCs in PD-MCI patients and PD patients with normal cognition (PD-NC).Results: Furthermore, 42 (42.3%) participants reported SCCs and 53 (53.5%) participants were diagnosed with PD-MCI. The prevalence of SCCs in PD-MCI and PD-NC participants was 30.3% and 12.1%, respectively. Logistic regression analyses revealed that the presence of SCCs in PD-MCI group was significantly associated with Non-Motor Symptoms Questionnaire (NMSQ) score (OR = 1.340, 95%CI = 1.115−1.610, p = 0.002), while the presence of SCCs in PD-NC group was significantly associated with time of Stroop Color-Word Test card C (OR = 1.050, 95%CI = 1.009−1.119, p = 0.016).Conclusion: SCCs are frequent among patients with early PD. The prevalence and risk factor of SCCs are distinct in PD with and without MCI. These findings suggest that SCCs in early PD with different cognitive status appear to have different pathogenicity.

Abstract 2640: Montreal Cognitive Assessment as a Short and Valuable Cognitive Evaluation in Acute Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
ANNA POGGESI ◽  
MARCO PASI ◽  
EMILIA SALVADORI ◽  
DOMENICO INZITARI ◽  
Leonardo PANTONI
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Acute Stroke ◽  
Acute Phase ◽  
Cognitive Assessment ◽  
Cognitive Status ◽  
Montreal Cognitive Assessment ◽  
Independent Effect ◽  
Stroke Patients

Background: Stroke patients are at high risk of developing dementia, but no agreement exists on what instrument should be used in the acute stroke phase to detect patients at higher risk of cognitive decline. Our aims were to investigate: 1) the feasibility and applicability of the Montreal Cognitive Assessment (MoCA) test in the acute phase of stroke; 2) the predictive value of MoCA on the diagnosis of cognitive impairment. Methods: Consecutive stroke patients (ischemic or hemorrhagic) admitted to our Stroke Unit were evaluated with MoCA between 5-9 days after stroke. Pre-morbid functional and cognitive status were assessed by a structured interview to caregivers. Neuroimaging information was collected regarding index and pre-existing lesions (number and site of lesions, leukoaraiosis, atrophy). Clinical and neuropsychological follow-up was scheduled after 6 months. Results: From December 2009 to December 2010, out of 208 patients with stroke, 138 (66%) were enrolled [mean age 69.1+/-15.0; males 62%; mean NIHSS score 5.7+/-7.7]. Non-enrolment was mostly due to unfitting of the time window inclusion criteria. MoCA was applicable to 114/138 (83%) of enrolled patients and the mean score was 17.9+/-7.2. Multivariate analyses showed that non-applicability was associated with higher NIHSS scores [OR(95% CI)=1.4(1.2-1.7) for each point] and left sided lesions [OR(95% CI)=13.3(1.8-97.9)]. After 6 months, 73 patients (53%) have been re-assessed: 40 had cognitive impairment (6 dementia, 34 MCI), while the remaining 33 did not show any cognitive impairment. Using logistic regression model, considering clinical variables such as age, gender, years of schooling, NIHSS, and pre-morbid cognitive status, MoCA was the only predictor of cognitive decline [OR(95% CI)=1.4(1.2-1.6) for each test point]. When adding neuroimaging features to the model, the independent effect of MoCA was only slightly attenuated [OR(95% CI)=1.4(1.1-1.7)]. The other independent predictor of cognitive decline turned out to be leukoaraiosis severity [OR(95%CI)=0.4(0.2-0.9) for each point of the van Swieten scale]. Conclusions: Our preliminary results indicate that the MoCA is feasible and applicable in the acute phase of stroke. Moreover, MoCA seems to have a predictive effect on the diagnosis of cognitive decline at 6-month follow-up, making it a good candidate for cognitive screening in stroke setting.

Indicators for cognitive performance and subjective cognitive complaints in multiple sclerosis: a role for advanced MRI?

2013 ◽  
Vol 20 (8) ◽  
pp. 1131-1134 ◽  
Author(s):  
Hanneke E Hulst ◽  
Karin Gehring ◽  
Bernard MJ Uitdehaag ◽  
Leo H Visser ◽  
Chris H Polman ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Diffusion Tensor ◽  
Demographic Data ◽  
Gray Matter Volume ◽  
Cognitive Complaints ◽  
Disease Characteristics ◽  
Conventional Mri ◽  
Subjective Cognitive Complaints

Previous studies showed that advanced neuroimaging measures (functional MRI, diffusion tensor imaging) could distinguish multiple sclerosis (MS) patients with and without cognitive impairment. Are these measures indeed better indicators for cognitive impairment or subjective cognitive complaints than conventional MRI? Fifty MS patients and 29 controls were investigated. Regression analysis, including socio-demographic data, disease characteristics, psychological measures, and (advanced) neuroimaging, showed that worse cognitive performance was associated with male sex, lower education, and lower gray matter volume. Subjective cognitive complaints were associated with fatigue and less hippocampal atrophy. Advanced MRI measures did not add to the predictive power of our model.

Montreal cognitive assessment for evaluating cognitive impairment in Huntington’s disease: a systematic review

CNS Spectrums ◽  
2020 ◽  
pp. 1-19
Author(s):  
Elena Cecilia Rosca ◽  
Mihaela Simu
Keyword(s):  
Cognitive Impairment ◽  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Cognitive Assessment ◽  
Cognitive Status ◽  
Montreal Cognitive Assessment ◽  
Cutoff Score ◽  
Index Test ◽  
Cross Sectional ◽  
Cross Sectional Studies

Abstract Objective This study aims to systematically review evidence of the accuracy of the Montreal Cognitive Assessment (MoCA) for evaluating the presence of cognitive impairment in patients with Huntington’s disease (HD) and to outline the quality and quantity of research evidence available about the use of the MoCA in this population. Methods We conducted a systematic literature review, searching four databases from inception until April 2020. Results We identified 26 studies that met the inclusion criteria: two case–control studies comparing the MoCA to a battery of tests, three studies comparing MoCA to Mini-Mental State Examination, two studies estimating the prevalence of cognitive impairment in individuals with HD and 19 studies or clinical trials in which the MoCA was used as an instrument for the cognitive assessment of participants with HD. We found no cross-sectional studies in which participants received the index test (MoCA) and a reference standard diagnostic assessment composed of an extensive neuropsychological battery. The publication period ranged from 2010 to 2020. Conclusions In patients with HD, the MoCA provides information about disturbances in general cognitive function. Even if the MoCA demonstrated good sensitivity and specificity when used at the recommended threshold score of 26, further cross-sectional studies are required to examine the optimum cutoff score for detecting cognitive impairments in patients with HD. Moreover, more studies are necessary to determine whether the MoCA adequately assesses cognitive status in individuals with HD.

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