Screening for Neurocognitive Impairment in HIV Individuals: The Utility of the Montreal Cognitive Assessment Test

Screening for neurocognitive impairment in HIV-positive adults aged 50 years and older: Montreal Cognitive Assessment relates to self-reported and clinician-rated everyday functioning

“…We found a cut-off of ≤26 as the most optimal balance of sensitivity and specificity, which is somewhat higher than the ≤25 cut-point found in other studies in HIV (Chartier et al, 2015; Hasbun et al, 2012; Janssen et al, 2015; Ku et al, 2014; Milanini et al, 2014; Overton et al, 2013). Moreover, the optimal MoCA cut-off remained the same when participants with significant confounding neuromedical factors (e.g., history of stroke, severe head injury) were excluded from analyses.…”

“…The latter is particularly important in determining the clinical relevance and ecological validity of the MoCA. Some studies converge to support the MoCA as a practical and valid neurocognitive screening tool in HIV+ adults (Brouillette et al, 2015; Chartier et al, 2015; Hasbun et al, 2012; Koski et al, 2011; Ku et al, 2014; Overton et al, 2013; Robbins et al, 2013; Valcour, 2011), although not sufficient as a stand-alone tool for diagnosing HAND (Chartier et al, 2015; Janssen, Bosch, Koopmans, & Kessels, 2015). To our knowledge, only one study has examined the MoCA as a neurocognitive screener in older HIV+ adults and found the MoCA moderately sensitive and specific for HIV+ adults aged 60 and older, yielding 72% sensitivity and 67% specificity with a cut-off of ≤25 (Milanini et al, 2014).…”

Utility of Using the Montreal Cognitive Assessment (MoCA) as a Screening Tool for HIV-Associated Neurocognitive Disorders (HAND) In Multi-Ethnic Malaysia

“…It has greater sensitivity in detecting HIV-related cognitive impairment when compared to other measures such has the MMSE and HDS [39, 40]. Taking these advantages into consideration, the current study further improves the utility of the MoCA by developing demographically corrected impairment status in a large Malaysian HIV-positive cohort on cART.…”

“…When compared to other screening tools, the MoCA is advantageous in that it is relatively comprehensive as it assesses short-term memory recall, visuospatial ability, executive functioning, attention, concentration and working memory, language, and orientation to time and place [9]. A cut-off score of ≤ 26 is recommended to detect a mild degree of cognitive deficit [9] and it has been used in PLWH populations [10, 11] with relative success. Although the MoCA was originally developed and standardized in Canada, it is easily adaptable to other languages and cultural settings.…”

Evidence-based perspectives on the implementation of screening for neurocognitive impairment in HIV

“…In a study by Joska et al, 108 the MoCA showed higher sensitivity and lower specificity than any of the other tools used in the study (including the HDS, IHDS, MMSE, and Simioni symptom questionnaire [SSQ]). A study in the US found results close to those of Joska, 109 while work in the Netherlands showed similar high sensitivity and low specificity only when used at a cut-off of 28.5; at standard cut-off, both statistics were closer to 60%. 110 In the Dutch study, the area under the receiver-operator curve suggested that the MoCA was diagnostically similar to the HDS.…”