Montreal Cognitive Assessment (MoCA) for HIV-Associated Neurocognitive Disorders

Abstract

This study aims to systematically review the evidence on the accuracy of the Montreal Cognitive Assessment (MoCA) test for diagnosing HIV-associated neurocognitive disorders (HAND) and to outline the quality and quantity of research evidence available about the accuracy of MoCA in populations infected with HIV. We conducted a systematic literature review, searching five databases from inception until January 2019. We extracted dichotomized positive and negative test results at various thresholds and calculated the sensitivity and specificity of MoCA. Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Eight cross-sectional studies met the inclusion criteria for meta-analysis. Overall, 1014 patients were included but most studies recruited small samples. Recruitment period ranged from 2009 to 2015. We assessed most studies as being applicable to the review question though we had concerns about the selection of participants in three studies. The accuracy of MoCA for diagnosing HAND was reported at six cutoff points (scores 22-27). The MoCA test provides information about general cognitive functioning disturbances that contribute to a diagnosis of HAND. A lower threshold than the original cutoff of 26 is probably more useful for optimal screening of HAND, as it lowers false positive rates and improves diagnostic accuracy. Nonetheless, the choice of cutoff always comes with a sensitivity-specificity trade-off, the preferred cut point depending on whether sensitivity or specificity is more valuable in a given context. This is a post-peer-review, pre-copyedit version of an article published in Neuropsychology Review.

Enhancing care for people living with HIV: current and future monitoring approaches

“…Having a common and thoughtful diagnostic gold standard would subsequently help at identifying the most suitable screening tools. In this regard, specific techniques of brain magnetic resonance imaging, such as structural MRI and spectroscopy, will potentially help to better detect HAND, giving objective and quantifiable measures of brain involvement [89], since cerebrospinal fluid biomarkers have not proved to be reliable tools and noninvasive procedures should be preferred. Cerebrospinal fluid levels of Neurofilament Light Protein (NFL) and potentially serum levels, if clinically validated, may provide additional information in the setting of central nervous system and neuronal damage and for diagnosing symptomatic HAND [90].…”

Parkinson’s Disease-Cognitive Rating Scale for Evaluating Cognitive Impairment in Parkinson’s Disease: A Systematic Review

“…At present, this threshold is widely used for detecting cognitive impairment. However, recent systematic reviews investigating its use in patients with different types of cognitive disorders have revealed that lowering the threshold offers a better balance between true positive and false positive results [ 32 , 33 , 34 , 35 , 36 ]. In order to minimize practice effects, alternative versions of the MoCA have been developed.…”

Prevalence of HIV‐associated neurocognitive disorder (HAND) in Turkey and assessment of Addenbrooke’s Cognitive Examination Revised (ACE‐R) test as a screening tool

“…A systematic review evaluating eight studies reported an overall sensitivity of MoCA of 0.73, with a specificity of 0.54 using the same cut-off. When a lower threshold score of 23 balancing true and false-positive results was used, the sensitivity and specificity were 44% and 79%, respectively [21]. Despite a moderate sensitivity and diagnostic accuracy, MoCA has been used in many clinics because of the lack of easy-to-use and free alternatives.…”