Comparison of Montreal Cognitive Assessment and Mini-Mental State Examination in Evaluating Cognitive Domain Deficit Following Aneurysmal Subarachnoid Haemorrhage

George Kwok Chu Wong,Wai Sang Poon,Karine Ngai,Sandy Wai Lam,Adrian Wong,Vincent Mok,Sonia Brucki

doi:10.1371/journal.pone.0059946

George Kwok Chu Wong, Wai Sang Poon + Show 5 more

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https://doi.org/10.1371/journal.pone.0059946

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Abstract

ObjectiveCognitive deficits are common after aneurysmal subarachnoid haemorrhage (aSAH), and clinical evaluation is important for their management. Our hypothesis was that the Montreal Cognitive Assessment (MoCa) is superior to the Mini-Mental State Examination (MMSE) in screening for cognitive domain deficit in aSAH patients.MethodsWe carried out a prospective observational and diagnostic accuracy study on Hong Kong aSAH patients aged 21 to 75 years who had been admitted within 96 hours of ictus. The domain-specific neuropsychological assessment battery, the MoCA and MMSE were administered 2–4 weeks and 1 year after ictus. A cognitive domain deficit was defined as a cognitive domain z score <−1.65 (below the fifth percentile). Cognitive impairment was defined as two or more cognitive domain deficits. The study is registered at ClinicalTrials.gov of the US National Institutes of Health (NCT01038193).ResultsBoth the MoCA and the MMSE were successful in differentiating between patients with and without cognitive domain deficits and cognitive impairment at both assessment periods. At 1 year post-ictus, the MoCA produced higher area under the curve scores for cognitive impairment than the MMSE (MoCA, 0.92; 95% CI, 0.83 to 0.97 versus MMSE, 0.77; 95% CI, 0.66 to 0.83, p = 0.009).InterpretationCognitive domain deficits and cognitive impairment in patients with aSAH can be screened with the MoCA in both the subacute and chronic phases.

Highlights

Aneurysmal subarachnoid haemorrhage accounts for only 3% of strokes, its profound consequences and unique window for intervention justify its classification as a separate entity [1]
Schweizer et al subsequently found that when applied to 32 aneurysmal subarachnoid haemorrhage (aSAH) patients at a mean time of 29 months after aSAH, the Montreal Cognitive Assessment (MoCA) was more sensitive to specific neurocognitive test scores than the Mini-Mental State Examination (MMSE), they did not assess cognitive domain deficits [6]
We recently reported the application of the Hong Kong version of MoCA in aSAH and neurosurgical patients following traumatic and spontaneous intracerebral haemorrhage [12,14]

Summary

Introduction

Aneurysmal subarachnoid haemorrhage (aSAH) accounts for only 3% of strokes, its profound consequences and unique window for intervention justify its classification as a separate entity [1]. The MMSE was originally designed to screen for Alzheimer’s disease, and does not encompass all of the cognitive deficits that might occur following a stroke. It is weak in its ability to measure executive functions, such as abstract thinking, judgment, problem solving and perception, all of which are relevant to the type of dementia associated with vascular disease. Schweizer et al subsequently found that when applied to 32 aSAH patients at a mean time of 29 months after aSAH, the MoCA was more sensitive to specific neurocognitive test scores than the MMSE, they did not assess cognitive domain deficits [6]. Found that as a screening assessment for cognitive impairment, MoCA was not superior to MMSE with adjusted cutoff scores in subacute stroke patients [13]

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