The Montreal Cognitive Assessment (MoCA) as a cognitive screen in addiction health care: A validation study for clinical practice

Bruijnen, C.J.W.H.; Jansen, M.C.J.F.; Dijkstra, B.A.G.; Walvoort, S.J.W.; Lugtmeijer, Selma; Markus, Wiebren; Jong, C.A.J. de; Kessels, Roy P. C.

doi:10.1080/14659891.2018.1497102

Cited by 22 publications

(32 citation statements)

References 35 publications

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“…Post‐hoc tests revealed that only patients using alcohol performed significantly worse on the MoCA total score than those using cannabis (Table ). However, taking into consideration the sensitivity and specificity of the MoCA in addiction care , a rather high proportion of patients with actual cognitive impairments may remain undetected, while at the same time cognitively intact patients are classified as being cognitively impaired by the MoCA.…”

Section: Resultsmentioning

confidence: 99%

“…The small number of patients using sedatives and gamma‐hydroxybutyrate were not included in the comparisons making it impossible to conclude about consequences on cognitive functioning for these substances. Finally, the rather low sensitivity and specificity of the MoCA for use in addiction care may have influenced our results and therefore the actual prevalence of cognitive impairments may well be different than that currently found.…”

Section: Discussionmentioning

confidence: 99%

“…An adjustment for level of education is applied in which participants with a low level of education are awarded two extra points and participants with an average level of education are awarded one extra point, maintaining the maximum score of 30 . In addiction care, an optimal cut‐off score of 24 was found to be predictive of substance‐induced cognitive impairments, with a sensitivity of 0.56 and a specificity of 0.62, using an extensive neuropsychological assessment as gold standard .…”

Section: Methodsmentioning

confidence: 99%

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Prevalence of cognitive impairment in patients with substance use disorder

Bruijnen

Dijkstra

Walvoort

et al. 2019

Drug and Alcohol Review

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114

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Introduction and Aims Cognitive impairments in substance use disorder predict treatment outcome and are assumed to differ between substances. They often go undetected, thus the current study focuses on the prevalence of and differences in cognitive functioning across substances by means of a cognitive screen at the early stage of addiction treatment. Design and Methods The Montreal Cognitive Assessment was administered to outpatients seeking treatment for substance use disorder. Patient characteristics (age, years of regular use, polysubstance use, severity of dependence/abuse, depression, anxiety and stress) were also taken into account. Results A total of 656 patients were included (n = 391 used alcohol, n = 123 used cannabis, n = 100 used stimulants and n = 26 used opioids). The prevalence of cognitive impairments was 31%. Patients using alcohol had a lower total‐ and memory domain score than those using cannabis. Patients using opioids scored lower on visuospatial abilities than those using cannabis or stimulants. Younger patients scored higher than older patients. No effect was found for the other investigated characteristics. Discussion and Conclusions Given the high prevalence of cognitive impairments, standard screening at an early stage of treatment is important to determine the course of treatment and maximise treatment outcome. Caution is needed in interpreting results about opioids due to an underrepresentation of this patient group, and more research is needed on the effect of age on Montreal Cognitive Assessment performance.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Prevalence of cognitive impairment in patients with substance use disorder

Bruijnen

Dijkstra

Walvoort

et al. 2019

Drug and Alcohol Review

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114

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“…The MoCA was developed to be more sensitive to mild cognitive impairment in geriatric populations than other screeners, like the Mini Mental State Examination (MMSE; Folstein et al 1975), and has been translated into nearly 100 languages. Besides geriatrics, the MoCA is widely used in, for instance, substance use, HIV and hepatitis C (Bassiony et al 2015;Bruijnen et al 2016;Copersino et al 2009;Janssen et al 2015). Although the MoCA has gained wide support, research focussing on its psychometric properties, such as alternate-form-, test-retest-and inter-rater reliability, has yielded mixed findings.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, they suggested to add one 'correction point' to scores of individuals with 12 years of education or less. Bruijnen et al (2019) recently proposed a more fine-grained correction method based on the level of education, rather than its duration, where individuals with a low level of education receive two additional points and those with an average level of education receive one additional point. Only one study correlated MoCA scores with general intellectual abilities and found a correlation of 0.64 (Sugarman and Axelrod 2014).…”

Section: Introductionmentioning

confidence: 99%

Psychometric properties of the Montreal Cognitive Assessment (MoCA) in healthy participants aged 18–70

Bruijnen

Dijkstra

Walvoort

et al. 2020

International Journal of Psychiatry in Clinical Practice

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Objectives: The Montreal Cognitive Assessment (MoCA) is a cognitive screen, available in three alternate versions. Aims of the current study were to examine the effects of age, education and intelligence on MoCA performance and to determine the alternate-form equivalence and test-retest reliability of the MoCA, in a group of healthy participants. Method: In 210 participants, two MoCA versions and an estimator for premorbid intelligence were administered at two time points. Results: Age, education and estimated premorbid intelligence correlated significantly with the total score (MoCA-TS) and the Memory Index Score (MoCA-MIS). Systematic differences between MoCA version 7.1 and alternate versions 7.2 and 7.3 were only found for the items animal naming, abstract reasoning and sentence repetition. Test-retest reliability of the MoCA-TS was good between 7.1 and 7.2 (ICC: 0.64) and excellent between 7.1 and 7.3 (ICC: 0.82). For the MoCA-MIS, coefficients were poor (ICC: 0.32) to fair (ICC: 0.48), respectively. Conclusion: Adequate norms are needed that take the effects of age, education and intelligence on MoCA performance into account. All three MoCA versions are largely equivalent based on MoCA-TS and the test-retest reliabilities show that this score is suitable to monitor cognitive change over time. Comparisons of the domain-specific scores should be interpreted with caution. KEY POINTS The MoCA total score is a reliable cognitive measure. All three MoCA versions are largely equivalent. Age, education and intelligence are predictors of MoCA performance in healthy participants. Future studies should focus on collecting normative data for age, education and intelligence for use in clinical practice.

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Assessment of Neurocognitive Impairment and Speech Functioning Before Head and Neck Cancer Treatment

Piai

Prins²,

Leeuw

et al. 2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Head and neck cancer (HNC) and its treatment may negatively alter neurocognitive and speech functioning. However, the prevalence of neurocognitive impairment among patients with HNC before treatment is poorly studied, and the association between neurocognitive and speech functioning is unknown, which hampers good interpretability of the effect of HNC treatment on neurocognitive and speech function.OBJECTIVES To document neurocognitive functioning in patients with HNC before treatment and to investigate the association between neurocognitive and speech functioning. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of newly diagnosed patients with HNC before treatment using a large sample obtained in a nationwide, multicenter setting (Netherlands Quality of Life and Biomedical Cohort Study in Head and Neck Cancer [NET-QUBIC] project). MAIN OUTCOME AND MEASURESObjective neuropsychological measures of delayed recall, letter fluency, and executive functioning, as well as patient-reported outcome measures on neurocognitive speech and functioning, were collected before treatment. RESULTSIn total, 254 patients with HNC participated (71.7% male), with a mean (SD) age of 62 (10) years. The response rate ranged from 81.9% (208 of 254) to 84.6% (215 of 254). Objective neurocognitive measures indicated that 4.7% (10 of 212) to 15.0% (32 of 214) of patients were initially seen with moderate to severe cognitive impairment. Mild to moderate impairment was found in 12.3% (26 of 212) to 26.2% (56 of 214) of patients. The most altered domains were delayed recall and letter fluency. Seven percent (15 of 208) of the patients reported high levels of everyday neurocognitive failure, and 42.6% (89 of 209) reported speech problems. Objective neurocognitive function was not significantly associated with patient-reported neurocognitive or speech functioning, but the results from patient-reported outcome measures were significantly correlated. CONCLUSIONS AND RELEVANCEResults of this study demonstrate a high prevalence of impaired speech functioning among patients with HNC before treatment, which is in line with previous findings. A novel finding is that neurocognitive impairment is also highly prevalent as objectively measured and as self-perceived. Understanding the reason why patients with HNC are initially seen with neurocognitive impairment before the start of treatment is important because this impairment may complicate patient-clinician interaction and alter treatment adherence and because treatment itself may further worsen cognitive functioning. In addition, low self-perceived neurocognitive and speech functioning before treatment may decrease a patient's confidence in communicative participation and perceived quality of life. Disentangling the associations between objective and patient-reported neurocognitive and speech functions is an important area for future research.

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The Montreal Cognitive Assessment (MoCA) as a cognitive screen in addiction health care: A validation study for clinical practice

Cited by 22 publications

References 35 publications

Prevalence of cognitive impairment in patients with substance use disorder

Prevalence of cognitive impairment in patients with substance use disorder

Psychometric properties of the Montreal Cognitive Assessment (MoCA) in healthy participants aged 18–70

Assessment of Neurocognitive Impairment and Speech Functioning Before Head and Neck Cancer Treatment

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