Underestimation of cognitive impairments by the Montreal Cognitive Assessment (MoCA) in an acute stroke unit population

Chan, Edgar; Khan, Sabah; Oliver, Rupert; Gill, Sumanjit K.; Werring, David J.; Cipolotti, Lisa

doi:10.1016/j.jns.2014.05.005

Cited by 64 publications

(65 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For the specific measures based on Chan et al (18), first we investigated the 16 MoCA-Intact patients for impairment in each cognitive domain assessed by the CA. Of these patients, 56.3% were impaired in at least one of the six cognitive domains.…”

Section: Resultsmentioning

confidence: 99%

“…For each individual cognitive test, patients were classified as cognitively impaired if they scored <5th percentile (i.e., 5% cut-off), with an intact performance ≥5% cut-off [for similar methodology, see Ref. (18, 39)]. For the Proverb Interpretation Test of verbal abstraction, an impaired performance was a score of <5/8 [for scoring details, see Ref.…”

Section: Methodsmentioning

confidence: 99%

“…For the CA, we calculated the number of patients impaired on any test and also the number of cognitive domains each patient was impaired in (i.e., 0–6 cognitive domains). Second, based on the method adopted by Chan and colleagues for stroke patients (18), we conducted two specific analyses: (1) MoCA-Intact patients were investigated for impairment in each cognitive domain assessed by the CA; and (2) Patients who scored the maximum points in each of the MoCA-specified cognitive domains, irrespective of the overall MoCA score, were analyzed in terms of discrepancy between this and performance on the domain relevant CA test. We also analyzed whether the MoCA-Impaired patients were impaired in at least one cognitive domain.…”

Section: Methodsmentioning

confidence: 99%

“…Neuropsychological evaluations are held to be the “gold standard” for assessment of cognitive functions in focal neurological disorders like stroke (15, 18). However, evaluations differ in test composition and can range from long and comprehensive, with a fixed test battery, to brief and flexible, with tests chosen to assess specific cognitive domains (19).…”

Section: Introductionmentioning

confidence: 99%

“…The MoCA was concluded to be more sensitive than the MMSE in SAH; however, it was not clear that the MoCA had sufficient sensitivity when compared to the neuropsychological assessment (15). Recently, a large retrospective study of acute stroke has unequivocally demonstrated that the MoCA underestimated cognitive impairment, compared to a brief 1–2 h neuropsychological assessment (18). …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Cognitive Screening in Brain Tumors: Short but Sensitive Enough?

2015

View full text Add to dashboard Cite

Cognitive deficits in brain tumors are generally thought to be relatively mild and non-specific, although recent evidence challenges this notion. One possibility is that cognitive screening tools are being used to assess cognitive functions but their sensitivity to detect cognitive impairment may be limited. For improved sensitivity to recognize mild and/or focal cognitive deficits in brain tumors, neuropsychological evaluation tailored to detect specific impairments has been thought crucial. This study investigates the sensitivity of a cognitive screening tool, the Montreal Cognitive Assessment (MoCA), compared to a brief but tailored cognitive assessment (CA) for identifying cognitive deficits in an unselected primary brain tumor sample (i.e., low/high-grade gliomas, meningiomas). Performance is compared on broad measures of impairment: (a) number of patients impaired on the global screening measure or in any cognitive domain; and (b) number of cognitive domains impaired and specific analyses of MoCA-Intact and MoCA-Impaired patients on specific cognitive tests. The MoCA-Impaired group obtained lower naming and word fluency scores than the MoCA-Intact group, but otherwise performed comparably on cognitive tests. Overall, based on our results from patients with brain tumor, the MoCA has extremely poor sensitivity for detecting cognitive impairments and a brief but tailored CA is necessary. These findings will be discussed in relation to broader issues for clinical management and planning, as well as specific considerations for neuropsychological assessment of brain tumor patients.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cognitive Screening in Brain Tumors: Short but Sensitive Enough?

2015

View full text Add to dashboard Cite

show abstract

Patient‐specific cognitive profiles in the detection of dementia subtypes: A proposal

Mueller

Cammermeyer²

2023

Alzheimer's & Dementia

View full text Add to dashboard Cite

Many physicians rely on sum score cognitive screening tests to evaluate patients for cognitive decline. Because the vast majority of cognitively impaired patients never receive more extensive testing, the results of these screening tests impact patients and their family members profoundly. No previous study has examined whether the metrics used by the popular Mini‐Mental State Examination, Montreal Cognitive Assessment, and Saint Louis University Mental Status tests reliably identify single‐domain deficits or allow clinicians to adequately track disease progression. We compare side by side the metrics used by these three tests to highlight the differences in the ways they measure domain impairments. We then contrast the sum score approach to cognitive screening with brief domain‐specific tests that use extended metrics in each domain examined. Last, we suggest that moderate‐to‐severe domain‐specific deficits on these tests should lead physicians to anticipate specific functional problems and alert family members.

show abstract

Global iterative optimization framework for predicting cognitive function statuses of patients with end‐stage renal disease

Sheng

Zhang

Shi

et al. 2023

Int J Imaging Syst Tech

View full text Add to dashboard Cite

The existing methods to determine the cognitive function level of end-stage renal disease (ESRD) are not only inaccurate but also susceptible to the influence of the patient's education level, emotional state, and examination environment. We proposed a global iterative optimization framework (GIO) to accurately predict cognitive function statuses of ESRD patients without being affected by the above factors. First, the functional magnetic resonance imaging (fMRI) data preprocessed and the time series were extracted to construct brain functional networks. Secondly, the areas under curve (AUC) of topological attribute parameters in the brain functional networks were extracted as features. After statistical analysis, the global efficiency, the characteristic path length, and the shortest path length in the small-world network were selected as features for linear fusion. Finally, the support vector regression (SVR) was used as the basis of GIO framework, and the global iterative search strategy was introduced to find out the most appropriate penalty factor and radial basis function parameters. Achieving the objective of accurately predicting the cognitive function status of patients with end-stage renal disease. Since this framework uses SVR which has special advantages in processing small sample data, and introduces appropriate parameter selection method, the prediction ability of GIO framework has been significantly improved. Experimental results demonstrate that the final prediction accuracy of the proposed framework is significantly better than those of SVR, LSSVR, GMO-SVR, GMO-LSSVR, and PSO-SVR. The mean absolute error (MAE) and the mean absolute percentage error (MAPE) of the proposed framework are 0.55% and 2.58%, respectively. It is suggested that this framework is more convenient to determine the current level of cognitive function in ESRD patients and is conducive to the early prevention of cognitive dysfunction in ESRD patients.

show abstract

Underestimation of cognitive impairments by the Montreal Cognitive Assessment (MoCA) in an acute stroke unit population

Cited by 64 publications

References 19 publications

Cognitive Screening in Brain Tumors: Short but Sensitive Enough?

Cognitive Screening in Brain Tumors: Short but Sensitive Enough?

Patient‐specific cognitive profiles in the detection of dementia subtypes: A proposal

Global iterative optimization framework for predicting cognitive function statuses of patients with end‐stage renal disease

Contact Info

Product

Resources

About