Sensitivity of the Montreal Cognitive Assessment for Out-Patients With Mild Traumatic Brain Injury

Abstract

We aimed to assess the sensitivity of the Montreal Cognitive Assessment (MoCA) to screen for cognitive impairments amongst patients with mild traumatic brain injury (mTBI) seen in an outpatient head injury clinic. Our research questions: 1) What proportion of assessed patients demonstrated cognitive impairments as per the MoCA? 2) What patient factors were associated with cognitive impairment as per the MoCA? Cross sectional survey. Level 1 tertiary care urban outpatient head injury clinic. mTBI patients (n=117) assessed between July 2013 and January 2014. Not applicable. MoCA overall and sub-component scores. Patients were assessed on average 37 weeks (range 0-329 weeks) post-injury. Overall, 41.8% (n=49) were cognitively impaired as per the MoCA (score <26/30). The naming and delayed recall sub-components were the most challenging for patients, with 99% (n=116) and 79% (n=92) demonstrating impairments in these components, respectively. Multiple linear regression was used to identify patient specific factors associated with MoCA scores. Controlling for gender, increasing patient age (p=.03), and higher Rivermead Post-Concussion Symptom Questionnaire score (p=.004) were significantly associated with decreasing MoCA scores, collectively explaining 31% of the variance. Duration of loss of consciousness, history of mental illness, history of drug use, and use of alcohol a month prior to injury were not significant in the model. Our findings were similar using Logistic Regression (outcome measured by MoCA score <26/30 versus ≥26/30). The MoCA is sensitive in detecting cognitive impairments amongst patients with persisting post-concussive symptoms assessed in an outpatient setting months following injury.