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Montreal Cognitive Assessment in cryptogenic epilepsy patients with normal Mini-Mental State Examination scores
Kanitpong Phabphal1, Janyapon Kanjanasatien
1Department of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. pkanitpo@medicine.psu.ac.th
Abstract:
This cross-sectional study examined the Montreal Cognitive Assessment (MoCA) performance in cryptogenic epileptic patients aged more than 15 years with normal global cognition according to the Mini-Mental State Examination (MMSE) score. We tested our hypothesis that the prevalence of mild cognitive impairment and associated patient correlation factors might be increased (score < 26) according to the MoCA, in spite of a normal MMSE score, and that cognitive impairment might occur in a range of domains of the MoCA. Eighty-five patients participated in this study. The mean MoCA score was 22.44 (± 4.32). In spite of a normal MMSE score, which was an inclusion criterion, cognitive impairment was detected in 60% patients based on the MoCA score. The variable that correlated with a higher risk of cognitive impairment was the number of antiepileptic drugs (polytherapy: OR 2.71; CI 1.03-7.15). The mean scores of visuospatial and executive function, naming ability, attention, language, abstraction, delayed recall and orientation among patients with mild cognitive impairment were significantly lower than those of patients with normal cognitive function. These findings suggest that mild cognitive impairment in cryptogenic epileptic patients is common. We suggest using MoCA as a screening test for patients with epilepsy.
Insights
Mild cognitive impairment is common in cryptogenic epilepsy patients, even with normal global cognition scores. Polytherapy with antiepileptic drugs increases this risk, suggesting the Montreal Cognitive Assessment (MoCA) as a valuable screening tool.
Area of Science:
- Neurology
- Neuropsychology
- Epileptology
Background:
- Cryptogenic epilepsy affects global cognition, but mild cognitive impairment (MCI) may be overlooked.
- The Mini-Mental State Examination (MMSE) may not detect subtle cognitive deficits in epilepsy patients.
- The Montreal Cognitive Assessment (MoCA) may offer a more sensitive measure of cognitive function.
Purpose of the Study:
- To investigate the prevalence of mild cognitive impairment (MCI) in cryptogenic epilepsy patients with normal MMSE scores.
- To identify factors associated with MCI in this patient population.
- To evaluate the utility of the MoCA in detecting cognitive deficits in epilepsy.
Main Methods:
- Cross-sectional study of 85 cryptogenic epilepsy patients over 15 years old.
- All participants had normal global cognition as per MMSE.
- Montreal Cognitive Assessment (MoCA) was used to assess cognitive function; scores below 26 indicated MCI.
Main Results:
- Cognitive impairment was detected in 60% of patients using MoCA, despite normal MMSE scores.
- Polytherapy (multiple antiepileptic drugs) was associated with a significantly higher risk of MCI (OR 2.71).
- Patients with MCI showed significantly lower mean scores across multiple cognitive domains, including visuospatial function, executive function, and memory.
Conclusions:
- Mild cognitive impairment is highly prevalent in cryptogenic epilepsy patients, often undetected by MMSE.
- The number of antiepileptic drugs used is a significant risk factor for cognitive impairment.
- The MoCA is a sensitive screening tool for detecting mild cognitive impairment in epilepsy patients, aiding in timely intervention.
