Leigh E. Charvet, Emily Taub , Bianca Cersosimo, Christopher Rosicki, Patricia Melville and Lauren B. Krupp
Background: The Montreal Cognitive Assessment (MoCA) is quickly becoming the most common clinical screen for cognitive impairment. Cognitive impairment is a frequent symptom of multiple sclerosis (MS) and can be difficult to detect in routine evaluation. Although specific screening measures have been studied and established for use in MS, MS cognitive screening tools may not be implemented in a general neurology setting.
Method: The present study sought to characterize the use of the Montreal Cognitive Assessment (MoCA) a brief measure employed in general neurologic practice for the detection of cognitive impairment in MS. The MoCA, along with other clinical measures, was administered to consecutively-recruited outpatients diagnosed with MS (N=259) to describe the findings and determine the frequency of detection of impairment. A subgroup (n=28) was also administered the oral version of the Symbol Digit Modalities Test (SDMT) as a measure of information processing speed.
Results: Participants' mean age was 45.8 ± 13.3 years and were diagnosed with relapsing-remitting MS (66%), secondary-progressive MS (18%), primary progressive MS (10%), clinically isolated syndrome (6%) or radiologically isolated syndrome (<1%). Median EDSS score was 2.5. A total of 41% of the sample scored in the impaired MoCA range (cutoff score of 26) with a mean of 25.86 ±2.92 points. EDSS was the clinical variable that most strongly predicted MoCA score. The combined SDMT and MoCA score led to the strongest prediction of EDSS score.
Conclusion: In an outpatient setting where MS-specific cognitive screening is not implemented, the MoCA can be a helpful to identify those MS patients who warrant full neuropsychological evaluation.