Performances on the Montreal Cognitive Assessment Along the Cardiovascular Disease Continuum

Abstract

Cardiovascular diseases involve a continuum starting with risk factors, which can progress to coronary heart disease and eventually, to heart failure. Cognitive impairment (CI) is observed as early as cardiovascular risk factors, and in up to 50% of patients with heart failure. Because CI in cardiovascular disease is linked to poorer clinical outcomes, early detection is essential. The Montreal Cognitive Assessment (MoCA) is a screening tool widely used in clinical setting. To date, little is known about MoCA scores along the cardiovascular disease continuum. Objective This study compared performances of different cardiovascular disease profiles on the MoCA and its subscores. Method Eighty participants (>50 years) from two studies conducted at the Montreal Heart Institute were separated into four groups: low cardiovascular risk factors (<2), high cardiovascular risk factors (>2), coronary heart disease, and stable heart failure. ANCOVAs were performed on the total score and on subscores, with sex, age, and education as covariates. Results Group differences were observed on the MoCA total score (heart failure < low cardiovascular risk), verbal fluency (heart failure < low cardiovascular risk), memory (coronary heart disease < low cardiovascular risk), and orientation (coronary heart disease < low and high cardiovascular risk) subscores. Conclusion Results suggest that the MoCA, particularly verbal fluency and memory subscores, can detect cognitive changes in later stages of the cardiovascular disease continuum, such as heart failure. Detecting cognitive changes earlier on the cardiovascular disease continuum may require more in depth neuropsychological assessments.

Videoconference version of the Montreal Cognitive Assessment: normative data for Quebec-French people aged 50 years and older

“…Previous studies have shown that the MoCA is sensitive and can differentiate healthy older adults from adults with mild cognitive impairment and dementia [5]. Also, a previous study published by our group showed that the MoCA was useful to differentiate between different cardiovascular disease profiles [6]. Indeed, participants with stable heart failure obtained both statistically and clinically significant lower total MoCA scores than participants with low cardiovascular risk factors.…”

“…In response to the COVID-19 crisis, Klil-Drori and collaborators [7] evaluated the use of a 20-point telephone version of the MoCA to establish a cut-off to determine normal cognitive functioning. The authors established a 17/20 cut-off, yet, they underlined that the Tele-MoCA is not sensitive enough to detect subtle cognitive impairments, such as mild cognitive impairment or dementia at its early stages [6]. Moreover, a telephone assessment does not allow observing the patient, which can add rich qualitative information to the assessment.…”

“…The objective of the present project was to create normative data for videoconference administration of the MoCA in Quebec-French people considering sociodemographic characteristics of participants. Finally, as total MoCA scores have been found to differ according to cardiovascular disease profile [6], an exploratory objective of the present study was to determine whether the presence of cardiovascular disease could contribute to the regression equation.…”

Women with Myocardial Infarction Present Subtle Cognitive Difficulties on a Neuropsychological Battery After Exposure to a Social Stressor

“… 14 Given that most women in our sample experienced their first MI event within the past 5 years (mean 2.5 years ± 1.98), one cannot exclude that cognitive deficits might have been too subtle to be detected by the neuropsychological assessment measures. Indeed, a recent study by Gagnon et al 43 showed that performance on the MoCA varied along the cardiovascular disease continuum, emphasizing the gradual cognitive decline linked to disease progression in these populations. In our study, WHx MI took significantly longer to complete the neuropsychological assessment than .…”

Cognitive impairment and depression in heart failure: ‘cardiological giants’

“…Although European guidelines consider screening for depressive symptoms good practice, they do not yet recommend screening for cognitive impairment [ 12 ]. Increasing evidence in the last 15 years indicates the MoCA to be the most suitable instrument for patients with heart failure because of its ability (in contrast to the Mini-Mental State Examination questionnaire) to detect (mild) impairments frequently seen in patients with heart failure, such as executive dysfunction [ 13 ]. However, although it is widely used, it is time-consuming and there is little experience in cardiology clinics.…”