Comparison of screening tests in the evaluation of cognitive status of patients with epilepsy

Abstract

ABSTRACT. Epilepsy, a chronic neurological condition which is associated with neurobiological and psychosocial changes, affects 0.5 to 1% of the world's population, presenting in most cases a deficit in reasoning, memory and attention. Objective: To contribute to the implementation of screening strategies for cognitive decline and memory deficits in patients with epilepsy. Methods: Two questionnaires, MMSE and MoCA, were used in this cross-sectional and observational study. Fifty-four patients diagnosed with different types of epilepsy (55% refractory) were assessed; they were all over 18 years old, of both genders, with autonomy to answer the questionnaire. They were followed exclusively at an outpatient clinic of the Neurology Service Department, specialized in epilepsy, which is part of the tertiary healthcare level of the Brazilian Unified Health System (SUS). Results: The final sample consisted of 54 patients. There was a significant correlation (p<0.001) between the scores of both tests, indicating that low values in the MMSE score also corresponded to low values in the MoCA score. Sensitivity was 90% (ROC curve adjusted) and 87.5% of the patients with a normal score in the MMSE test obtained alterations in the MoCA scores. None of them showed a low MMSE score with a normal MOCA score. The Spearman correlation coefficient was 0.80. Also, there was a significant relationship between both immediate memory and delayed recall memory and the type of seizure (p<0.03) and level of schooling (p<0.001), respectively. Conclusion: The MoCA is a well-suited test to be performed in epilepsy patients to evaluate their cognition as it seems more extensive and complete compared to MMSE.

Serum neurofilament light chain in patients with epilepsy and cognitive impairment

“…In our study, the patients with epilepsy had mild but substantial cognitive impairment compared with the healthy controls, as shown in previous studies 4,15,19,20 . The score on the MoCA‐J, but not the MMSE, was significantly lower in the epilepsy group versus the control group, which is in agreement with a previous study showing that the MoCA can be used to assess cognitive changes in patients with epilepsy, even in cases with normal MMSE scores 14 .…”

“…The MMSE is most commonly used as a screening test for the assessment of the severity of cognitive dysfunction. The MoCA‐J is another screening method that is used for the assessment of cognitive function, but has been shown to be more sensitive than MMSE to evaluate cognitive function in patients with epilepsy 14,15 . The FAB is a quick and brief screening test of cognitive impairment that is especially aimed at evaluating frontal lobe dysfunction, which is often reported in patients with epilepsy 8 .…”

“…The MoCA-J is another screening method that is used for the assessment of cognitive function, but has been shown to be more sensitive than MMSE to evaluate cognitive function in patients with epilepsy. 14,15 The FAB is a quick and brief screening test of cognitive impairment that is especially aimed at evaluating frontal lobe dysfunction, which is often reported in patients with epilepsy. 8 The TMT is widely used as a brief and simple neuropsychological assessment of executive function and consists of two parts: Part A (TMT-A) and Part B (TMT-B).…”