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A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
Screening for cognitive deficits using the Montreal cognitive assessment tool in outpatients ≥65 years of age with
Karen Harkness1, Catherine Demers, George A Heckman
1Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Insights
Cognitive impairment (CI) is common in older heart failure (HF) patients, with over 70% screening positive using the MoCA tool. Advanced HF symptoms and recent hospitalization increase the risk of CI in this population.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Heart failure (HF) is an independent risk factor for cognitive impairment (CI).
- The combination of HF and CI is linked to adverse outcomes like mortality and reduced quality of life.
- Early detection of CI in HF patients is crucial.
Purpose of the Study:
- To determine the prevalence of CI in older outpatients with HF.
- To assess the utility of the Montreal Cognitive Assessment (MoCA) as a screening tool for CI in this population.
Main Methods:
- A cross-sectional descriptive study was conducted.
- The MoCA screening tool was administered to 44 outpatients with HF aged 65 years and older.
- Data were analyzed to identify correlations between MoCA scores and HF severity or hospitalization history.
Main Results:
- Over 70% of participants scored below the MoCA cutoff, indicating probable CI.
- CI was significantly more prevalent in patients with advanced HF (NYHA classes III-IV) compared to those with milder symptoms (classes I-II).
- Patients with recent hospital admissions were more likely to exhibit signs of CI.
Conclusions:
- The MoCA effectively screened for CI in older HF patients, revealing a high prevalence.
- Advanced HF and recent hospitalization are associated with a higher likelihood of CI.
- Further research is needed to explore the predictive value of MoCA-detected CI for adverse outcomes in HF.
Abstract:
There is strong evidence to suggest that heart failure (HF) is an independent risk factor for cognitive impairment (CI). The combination of CI and HF is associated with increased mortality, repeat hospitalization, and poor quality of life. The purpose of this pilot study was to determine the presence of CI in older patients with HF using the Montreal Cognitive Assessment (MoCA), a brief screening instrument for CI. We conducted a cross-sectional descriptive study using the MoCA in outpatients with HF who were ≥ 65 years of age. Forty-four patients (mean ± SD 76 ± 6.6 years of age) completed the MoCA. More than 70% of patients scored below the MoCA cutoff score of 26, suggesting the presence of CI. However, 91% of patients with New York Heart Association classes III to IV versus 52% of patients with classes I to II had a MoCA score < 26 (p = 0.004). Patients with a recent hospital admission were more likely to have a MoCA score < 26 versus patients without a recent hospital admission (89% vs 62%, respectively, p < 0.045). Cognitive domain subscores showing significant differences (p <0.01) were short-term memory, visuospatial function, executive function, and language. In conclusion, this study sample represented a group of older patients with HF and no suspected or documented CI, but screening with the MoCA detected CI in >70% of the sample. The presence of CI was significantly more common in patients with advanced HF symptoms or a recent hospitalization. Future studies need to determine if the MoCA can identify the presence of CI that is predictive of adverse clinical outcomes in the HF population.
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