Mini-Mental State Examination versus Montreal Cognitive Assessment: Rapid assessment tools for cognitive and functional outcome after aneurysmal subarachnoid hemorrhage

Schweizer, Tom A.; Al-Khindi, Timour; Macdonald, R. Loch

doi:10.1016/j.jns.2012.01.003

« BackJournal of the Neurological Sciences

Article in Press

Mini-Mental State Examination versus Montreal Cognitive Assessment: Rapid assessment tools for cognitive and functional outcome after aneurysmal subarachnoid hemorrhage

Tom A. Schweizer
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
- Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Heart and Stroke Foundation of Ontario Centre for Stroke Recovery, Toronto, Canada
- Corresponding author at: Division of Neurosurgery, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8. Tel.: +1 416 864 5504; fax: +1 416 864 5857.
Timour Al-Khindi
- Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
R. Loch Macdonald
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
- Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

Received 7 October 2011; received in revised form 21 December 2011; accepted 4 January 2012. published online 27 January 2012.
Corrected Proof

Abstract

Objective

Recent studies suggest that the Montreal Cognitive Assessment (MoCA) is more sensitive to stroke-associated cognitive dysfunction than the Mini-Mental State Examination (MMSE), but little is known about how these screening measures relate to neurocognitive test performance or real-world functioning in patients with good recovery after aneurysmal subarachnoid hemorrhage (aSAH). The aim of the present study was to determine how MoCA and MMSE scores relate to neurocognitive impairment and return to work after aSAH.

Methods

Thirty-two patients with aSAH who had made a good recovery completed the MoCA, the MMSE, and a battery of neurocognitive tests.

Results

42% and 0% of aSAH patients were impaired on the MoCA and MMSE, respectively. The MoCA had acceptable sensitivity (40–100%) and specificity (54–68%) (Table 3). The MMSE failed to detect impairment in any cognitive domain. The MoCA, but not the MMSE, predicted performance on tests of verbal learning, executive function, working memory, visuospatial function, and motor function. Superior performance on the Animal naming and Abstraction subtests of the MoCA score were associated with return to work following aSAH.

Conclusion

Compared to the MMSE, the MoCA is more sensitive to aSAH-associated cognitive impairment. Certain MoCA subtests are also sensitive to functional difficulties after aSAH such as return to work. These findings support the utility of the MoCA as a brief bedside assessment of cognitive and real-world outcome in aSAH survivors.

Keywords: Cognitive outcome, Screening tools, Subarachnoid hemorrhage