The Montreal Cognitive Assessment (MoCA) as a screening test for cognitive dysfunction in multiple sclerosis

Area of Science:

• Neuroscience
• Clinical Psychology

Background:

• Multiple sclerosis (MS) frequently causes cognitive dysfunction (CD).
• Early identification of CD is crucial for managing MS progression and patient outcomes.
• Screening tools need validation for specific populations and languages.

Purpose of the Study:

• To evaluate the Portuguese version of the Montreal Cognitive Assessment (MoCA) as a screening tool for CD in multiple sclerosis (MS).
• To determine the psychometric validity and discriminative capacity of the MoCA in an MS cohort.
• To identify optimal cut-off scores for detecting MS-related cognitive impairment.

Main Methods:

• A cohort of 118 participants, including 59 MS patients and 59 controls, underwent comprehensive neuropsychological assessment.
• The Portuguese MoCA was administered to all participants.
• Multiple Linear Regression analyses were used to identify factors influencing MoCA performance.

Main Results:

• The Portuguese MoCA demonstrated psychometric validity and good discriminative capacity between cognitively impaired and intact MS patients.
• A MoCA total score below 26 was identified as a cut-off for detecting CD in MS (AUC = 0.837).
• A novel EM-MoCA-Subscore (cut-off <17) showed high accuracy (AUC = 0.871) and can reduce screening administration time.

Conclusions:

• The Portuguese MoCA is a valid and sensitive instrument for screening cognitive dysfunction in multiple sclerosis.
• The proposed EM-MoCA-Subscore offers a time-efficient method for identifying MS-related cognitive impairment.
• These findings support the use of the MoCA in clinical settings for early detection of cognitive changes in MS patients.