Investigation of Cognitive Improvement in Alcohol-Dependent Inpatients Using the Montreal Cognitive Assessment (MoCA) Score

Abstract

Background. Cognitive dysfunction is a common feature in alcohol use disorders. Its persistence following alcohol detoxification may impair quality of life and increase the risk of relapse. We analyzed cognitive impairment changes using the Montreal Cognitive Assessment (MoCA) score in a large sample of alcohol-dependent inpatients hospitalized for at least 4 weeks. Method. This was an observational longitudinal survey. Inclusion criteria were alcohol dependence (DSM-IV) and alcohol abstinence for at least one week. The MoCA test was administered on admission and at discharge. Results. 236 patients were included. The mean MoCA score significantly increased from 22.1 ± 3.7 on admission to 25.11 ± 3.12 at discharge. The corresponding effect-size of improvement was high, 1.1 [95% CI 1.0–1.2]. The degree of improvement was inversely correlated with the baseline MoCA score. The rate of high and normal, that is, >26, MoCA values increased from 15.8% on admission to 53.8% at discharge. MoCA score improvement was not correlated with the total length of abstinence prior to admission. Conclusion. The MoCA score seems to be a useful tool for measuring changes in cognitive performance in alcohol-dependent patients. A significant improvement in cognitive function was observed whatever the degree of impairment on admission and even after a long abstinence period.

Determination of MoCA Cutoff Score in Patients with Alcohol Use Disorders

“…By considering the best balance between sensitivity and specificity, the cutoff score fell to 26 for uncorrected scores, that is, the same as that proposed for the detection of mild cognitive impairment (Nasreddine et al., ). As we used this cutoff in our previous studies, this confirms a posteriori the reliability of our results on the prevalence of cognitive impairment in alcoholics (Alarcon et al., ; Pelletier et al., ).…”

“…In a previous work, we evaluated the interest of MoCA administration in a large series of patients with AUD (Alarcon et al., ) and concluded that MoCA is an appropriate tool for detecting cognitive impairment in that population. We then showed that MoCA was a useful tool for measuring changes in cognitive performance in alcohol‐dependent inpatients (Pelletier et al., ). However, in these papers, we interpreted our results according to published data obtained in patients with neurological diseases unrelated to alcohol consumption.…”

“…Indeed, the MoCA was compared to a single test (RBMT‐3) assessing memory disorders (which is relevant for Korsakoff's disease) and not to a battery of neurological tests as in our study. Furthermore, the 2 tests, the MoCA and the RBMT‐3, were performed at different times, with a period between them which could reach several weeks, a period during which the cognitive functions are reported to improve (Pelletier et al., ).…”

“…Among neurological complications, cognitive dysfunctions are the most frequent, ranging from mild impairment to irreversible damage such as the Korsakoff syndrome (Pitel et al., ). The prevalence of cognitive dysfunction spans from 50 to 70% according to different studies (Alarcon et al., ; Copersino et al., ; Fein et al., ; Martin et al., ; Pelletier et al., ).…”

“…The MoCA test is also used by teams specialized in AUD because several domains targeted by this tool, such as executive functions, visuospatial domain, and memory, are impaired in alcoholic patients. Indeed, the MoCA test has been shown to be a convenient tool both to screen cognitive dysfunction among alcoholic patients (Alarcon et al., ; Copersino et al., ) and to assess the change in cognitive function after alcohol withdrawal (Likhitsathian et al., ; Pelletier et al., ).…”