The Montreal Cognitive Assessment (MoCA) in neuro-oncology: A pilot study of feasibility and utility in telehealth and in-person clinical assessments

Abstract

Background Cognitive impairments are a common burden for patients with primary CNS tumors. Neuropsychological assessment batteries can be too lengthy, which limits their use as an objective measure of cognition during routine care. The purpose of this study was to evaluate the feasibility and utility of the brief Montreal Cognitive Assessment (MoCA) in routine in-person and telehealth visits (as a result of the global COVID-19 pandemic) with neuro-oncology patients. Methods 71 adults with primary CNS tumors completed MoCA testing in-person (n=47) and via telehealth (n=24). Patient-reported outcomes (PROs), including symptom burden and interference, perceived cognition, general health status, and anxiety and depression, were and correlation analysis were included in this study. Feasibility was assessed through a provider satisfaction questionnaire. Results Patients were primarily White (83%), college-educated (71%) males (54%) with high grade tumors (66%). The average total score on the MoCA administered in-person was 25 (range: 6-30), with 34% classified as abnormal, and the average total score via telehealth was 26 (range: 12-30), with 29% classified as abnormal. Providers reported satisfaction in using the MoCA during routine clinical care, both in-person and via telehealth. Lower MoCA scores correlated with worse symptom severity, KPS, age, education, and previous treatment. Conclusions The MoCA was feasible in clinical and telehealth settings, and its relationship to clinical characteristics and PROs highlight the need for both objective and patient-reported measures of cognition to understand the overall cognitive profile of a patient with a CNS tumor.

The clinical and neurocognitive functional changes with awake brain mapping for gliomas invading eloquent areas: Institutional experience and the utility of The Montreal Cognitive Assessment

“…In addition, the results of comprehensive battery may be affected by the professional expertise and level of experience of the evaluators, limiting the scope of its application as routine tests. Therefore, researchers tried to investigate the use of MoCA in the primary brain tumor population, especially in the setting of global COVID-19 pandemic (16,42).…”

“…Other studies suggested that KPS, age, education, and previous treatment were associated with patient MoCA outcomes and that the cutoff score appropriate for neuro-oncology establishment required further validation (16,40). Therefore, based on our results, MoCA administration for neurocognitive monitoring was feasible and convenient for patients undergoing awake surgeries.…”

“…Preliminary results showed that TeleLanguage battery could provide convenient, optimized patient care and enable longitudinal clinical research (42). For MoCA tests, Jammula et al also reported a pilot study on the feasibility and utility of telehealth and in-person clinical assessments (16). Considering the unique nature of awake surgery, it is necessary to further evaluate the patients' language status with more specific tools to better help their neurofunctional recovery process in our future work.…”

“…The Montreal Cognitive Assessment (MoCA) is a brief screening tool that helps medical service providers make more informed medical decisions to assess a patient's cognitive health (14,15). Compared to comprehensive neuropsychological assessment batteries, which are too long and sophisticated for most patients in routine care, MoCA provides a short and sensitive enough tool to detect cognitive impairment, particularly in people with brain metastases (16,17). However, the utility and feasibility of MoCA for glioma patients receiving awake surgery have seldom been reported (10,18,19).…”

Validation of the German Montreal-Cognitive-Assessment-H for hearing-impaired

“…Therefore it is an imperative to reliably detect cases of cognitive impairment. Due to the high comorbidity of hearing loss and cognitive impairment ( Lin et al, 2013 ; Teipel et al, 2015 ; Fritze et al, 2016 ; Huang et al, 2023 ; Tamblay et al, 2023 ), cognitive screening has gained increasing awareness beyond geriatric or psychiatric settings ( Mordenfeld et al, 2020 ; Susano et al, 2020 ; Canavan and O’Donnell, 2022 ; Jammula et al, 2022 ; Tsui et al, 2022 ) including ENT departments and audiology ( Mosnier et al, 2018 ; Humes, 2020 ; Sanders et al, 2021 ; Völter et al, 2022 ).…”