Use of the MoCA Combined with the Fab for the Screening of Cognitive Dysfunction in Patients with Alcohol Use Disorders

Abstract

Objective: Cognitive dysfunction is common in patients with Alcohol Use Disorders (AUD). This impairment needs to be detected since it affects the quality of life of patients and compliance with therapeutic programs. As global cognitive and executive functions may be differently affected in AUD patients, we wondered whether, when diagnosing cognitive dysfunction, specific measurement of executive functioning could provide an incremental value that could be used in addition to global cognitive measurement. Methods: Cognitive status was evaluated at admission using the Montreal Cognitive Assessment (MoCA) test, the Frontal Assessment Battery (FAB) and a battery of Neuropsychological (NP) reference tests in 134 patients with AUD hospitalized in an addictions treatment unit. Results: Seventy patients (52%) had cognitive dysfunction according to the battery of Neuropsychological (NP) tests. Among these 70 patients, 59 (84%) and 38 (54%) had abnormal MoCA and FAB test results, respectively. Concordance between the MoCA and the FAB was weak (kappa = 0.27). Analysis through logistic regression showed that the Area under Curve (AUC) obtained with the MoCA test was a better single predictor of cognitive impairment (0.85) than that obtained with the FAB (0.73). Combining the two tests produced an AUC of 0.86, a value not significantly different from that obtained with the MoCA. Conclusions: The MoCA-FAB combination did not perform better than the MoCA alone as a screening tool for cognitive dysfunction among AUD patients. This confirms that the MoCA is an efficient screening tool since it can detect frontal as well as general cognitive disorders.