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

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.

Evaluation of Cognitive Functions of Patients with Anemia

“…Some studies addressed multisystem involvement, such as multiple sclerosis and systemic lupus erythematosus. In addition, studies aiming to see the mental integrity of individuals with chronic diseases such as heart failure and diabetes have also evaluated cognitive functions [10][11][12][13][14][15] . In iron deficiency anemia, oxygen capacity decreases, resulting from both anemia and the decrease of iron in the body.…”

Changes in levels of the antioxidant glutathione in brain and blood across the age span of healthy adults: A systematic review

“…The relationship between GSH levels and cognitive function, using the Montreal Cognitive Assessment (MoCA), was interrogated by half (2/4) the MRS studies, and no significant association was found in the ROIs investigated, namely medial frontal ( Hupfeld et al, 2021 ), sensorimotor ( Hupfeld et al, 2021 ) and occipital ( Emir et al, 2011 ). However, it should be noted that while MoCA can robustly detect mild cognitive impairment, detection of subtle cognitive impairments requires analyses of its sub-scores ( Charest et al, 2020 ), which were not conducted by the above-mentioned studies. In addition to cognition, one study assessed the relationship between GSH levels and mobility in the sensorimotor and frontal cortices ( Hupfeld et al, 2021 ).…”

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

“…The high reliability of the MoCA in MS patients has been demonstrated by several studies. The test has shown compatible psychometric properties with conventional, more extensive neuropsychological tests used in MS patients—the Brief Repeatable Battery (BRB) and the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) [ 28 , 29 ]. We found a good correlation between BICAMS and MoCA results and feel that the simultaneous application of these instruments increases their diagnostic capacity.…”

“…The test evaluates cognitive domains commonly affected in MS patients, such as executive function, visuospatial ability, attention/concentration, verbal fluency, and memory. It has demonstrated efficacy in evaluating cognitive dysfunction accompanying several chronic neurological disorders, including MS [ 28 , 29 ]. Finally, the patients' mental health was evaluated using the Beck Depression Inventory (BDI) [ 30 ].…”