MoCA Utility as a Quick Testing Tool for Neurocognitive Disorders in HIV Patients: Analysis of a Prospective Cohort

Abstract

Background Since the introduction of highly active antiretroviral therapy, asymptomatic and mild neurocognitive impairment are the main clinical manifiestations of HIV associated neurocognitive disorders (HAND), compromising adherence to treatment, daily performance, quality of life, and even increasing the risk of mortality. We do not have validated screening tools for early detection of HAND applicable to the routine medical visit. The Montreal Cognitive Assessment test (MoCA) is a simple questionnaire used in Alzheimer’s disease, but its utility as a screening tool for HAND remains controversial.Methods We designed a prospective study to establish MoCA´s usefulness as a rapid and sensitive tool for the detection of HAND, compared with a gold-standard test (GST) that includes Mini-mental State Examination (MMSE) and a battery of assays that evaluate several neurological domains. Adult patients with HIV infection attending our institution were included. The MoCA test was performed by infectious diseases specialists, and the GST by neurologists. History of recent stroke, neurological disease, opportunistic central nervous system infection, major depression, schizophrenia, bipolar disorder, substance abuse or dependence on alcohol, were exclusion criteria. We analized demographic and clinical variables.ResultsFifty HIV-infected patients were enrolled, 94% males, with a mean age of 45.6 years (range 20–75), and an average of 14.8 years of education (range 3–26). The mean CD4 cell count was 596 cells/ml (range 65–1130), and 70% of the patients had undetectable viral load (≤20 copies/mL) at the time of the evaluation. Compared with GST, MoCA had a sensibility (S) of 94.12% (CI 71.3–99.8), specificity (E) 78.79% (CI 61.09–91.02), positive predictive value (PPV) 69.57% (CI 47–86.79) and negative predictive value (NPV) 96.3 (CI 81–99.9). In contrast, the MMSE presented S 11.76% (CI 1.46–36.44), E 100% (CI 89.4–100), PPV 100% (CI 15.8–100) and NPV 68.75% (CI 53.7–81.3). Cohen’s kappa coefficient between MoCA and GST was 0.67 (95% CI 0.46–0.87), reflecting an adequate agreement.Conclusion MoCA’s performance as a screening test was adequate compared with GST and far superior to MMSE for early detection of HAND. Although specifity could be optimized, MoCA test remains a valuable screening tool in the routine medical visit in our HIV population.Disclosures All authors: No reported disclosures.