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The Validity of the Montreal Cognitive Assessment for Moderate to Severe Traumatic Brain Injury Patients

A Pilot Study

Tay, Matthew Rong Jie MBBS (S’pore), MRCP (UK); Soh, Yan Ming BOT (Aus), Grad Dip Rehab Couns (Aus); Plunkett, Tegan Kate BOT (Aus), MClinRehab (NeuroOT) (Aus); Ong, Poo Lee MD, (Malaysia), MRCP (UK); Huang, Wanping BSocSc (Hons) (S’pore), DClinNeuroPsy (Aus); Kong, Keng He MBBS (S’pore), MRCP (UK), FAMS

American Journal of Physical Medicine & Rehabilitation: May 23, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001227
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Objective To pilot the use of Montreal Cognitive Assessment (MOCA) as a quick clinical screen for cognitive assessment in traumatic brain injury (TBI) patients.

Design The study recruited 61 participants with moderate to severe TBI presenting to a tertiary rehabilitation center under the Brain Injury Program. A MOCA questionnaire and neuropsychological battery (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS] and Color Trails Test[CTT]) were administered to participants who had completed inpatient rehabilitation.

Results Receiver Operating Characteristic (ROC) analysis for the MOCA revealed an optimal balance of sensitivity and specificity at 24/25 to discriminate participants who were classified as less than 5th centile on the Total Scale Index on the RBANS. This achieved a sensitivity, specificity, PPV and NPV of 73.9%, 86.5%, 77.3% and 84.2% respectively. ROC analysis for the trail making subtest of the MOCA achieved a sensitivity, specificity, PPV and NPV of 79.4%, 74.1%, 79.4% and 74.1% in identifying patients classified as less than 5th centile on CTT Part 2.

Conclusion The use of MOCA displayed good validity in identifying patients with clinically significant impairment on a standard neuropsychological assessment battery in the study population. However, it may lack sensitivity for estimating mild levels of impairment.

From the Tan Tock Seng Hospital Rehabilitation Center, Singapore

All correspondence and requests for reprints should be addressed to: Matthew Rong Jie Tay, Tan Tock Seng Hospital Rehabilitation Center, c/o TTSH Rehabilitation Center @ Ang Mo Kio-Thye Hua Kwan (AMK-THK), 17, Ang Mo Kio Ave 9, Singapore 569766, Republic of Singapore.

The authors confirmed that with regard to this submitted article, we have none of the following disclosures: competing interests, funding or grants or equipment from any source, and financial benefits to the authors, nor have we previously published any part or whole of this original work.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.