Mini-Mental State Examination versus Montreal Cognitive Assessment: Rapid assessment tools for cognitive and functional outcome after aneurysmal subarachnoid hemorrhage

Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
Journal of the neurological sciences (Impact Factor: 2.47). 01/2012; 316(1-2):137-40. DOI: 10.1016/j.jns.2012.01.003
Source: PubMed


Recent studies suggest that the Montreal Cognitive Assessment (MoCA) is more sensitive to stroke-associated cognitive dysfunction than the Mini-Mental State Examination (MMSE), but little is known about how these screening measures relate to neurocognitive test performance or real-world functioning in patients with good recovery after aneurysmal subarachnoid hemorrhage (aSAH). The aim of the present study was to determine how MoCA and MMSE scores relate to neurocognitive impairment and return to work after aSAH.
Thirty-two patients with aSAH who had made a good recovery completed the MoCA, the MMSE, and a battery of neurocognitive tests.
42% and 0% of aSAH patients were impaired on the MoCA and MMSE, respectively. The MoCA had acceptable sensitivity (40-100%) and specificity (54-68%) (Table 3). The MMSE failed to detect impairment in any cognitive domain. The MoCA, but not the MMSE, predicted performance on tests of verbal learning, executive function, working memory, visuospatial function, and motor function. Superior performance on the Animal naming and Abstraction subtests of the MoCA score were associated with return to work following aSAH.
Compared to the MMSE, the MoCA is more sensitive to aSAH-associated cognitive impairment. Certain MoCA subtests are also sensitive to functional difficulties after aSAH such as return to work. These findings support the utility of the MoCA as a brief bedside assessment of cognitive and real-world outcome in aSAH survivors.

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    • "More than half of our patients who scored the maximum points within the attention domain and one third of patients in the memory and visuospatial/ executive domains of the MoCA were impaired on comparable neuropsychological assessment. Our findings corroborate with a recent study which found poor correlation between performance on MoCA subtests and their neuropsychological counterpart [14]. The poor correspondence between performance on MoCA-specified domains and comparable neuropsychological assessment is most likely due to the lack of breadth and depth of screening items, and the absence of normative data to take into account factors such as age and pre-morbid intellectual functioning. "
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    ABSTRACT: Background and purpose: The Montreal Cognitive Assessment (MoCA) is an increasingly popular clinical screening tool for detecting cognitive impairment in stroke, but few studies have directly compared performance on the MoCA with neuropsychological assessment. Our retrospective study examined the extent to which intact performance on the MoCA reflects intact cognition as determined by neuropsychological assessment. Methods: In this retrospective study, cognitive profiles for 136 acute stroke patients admitted to the Acute Stroke Unit who had available MoCA and neuropsychological assessment data were examined. Results: 22% of our patients were deemed cognitively intact on the MoCA. Of these, 78% were found to be impaired (≤ 5%ile) on neuropsychological assessment in one or more cognitive domains. The most common impairments were in general intelligence, information processing speed and visual memory; three areas not assessed by the MoCA. In addition, a high proportion (up to 59%) of patients who scored the maximum points in one of the MoCA-specified domains were impaired on comparable neuropsychological assessment. Conclusions: Our findings suggest that although the MoCA may be a useful screening tool post-stroke in detecting gross impairments, neuropsychological assessment is still necessary for a comprehensive and reliable detection of domain-specific cognitive deficits, which can more reliably inform us for realistic goal setting and vocational advice vital for effective rehabilitation.
    Full-text · Article · May 2014 · Journal of the Neurological Sciences
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    • "All patients had at least ten years of education . The ruptured aneurysms were in the anterior communicating artery [10], middle cerebral artery [7] and posterior communicating artery [2] or in the posterior circulation system (basilar tip; 2). The mean time from SAH to testing was 59 months (SD = 96.8). "
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    ABSTRACT: Working memory impairments are prevalent among survivors of aneurysmal subarachnoid hemorrhage (SAH), but few studies have examined specifically these impairments. Such an examination is important because working memory processes are vital for daily cognitive functioning. In the current study, patients with SAH and healthy control participants were administered the word-span and alpha-span test - experimental tests of working memory. In the word-span test, participants recalled increasingly longer word-lists, requiring the maintenance of information in mind. In the alpha-span test, participants recalled the word-lists in alphabetical order, requiring both the maintenance and manipulation of information. Patients with SAH were no different from healthy controls on a battery of standard neuropsychological measures or on the word-span test. They were, however, significantly impaired on the alpha-span test, suggesting a deficit in the manipulation components of working memory. That is, impairment resulting from SAH is present when a working memory task requires additional executive processing demands. This deficit in patients with SAH does not appear to be influenced by aneurysm location, suggesting that some of the effects of SAH on cognition are from diffuse rather than focal pathology; however, a larger sample size is needed to reinforce this claim.
    Full-text · Article · Jul 2013 · Journal of the neurological sciences

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