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Minimum Clinically Important Difference of Montreal Cognitive Assessment in aneurysmal subarachnoid hemorrhage
George Kwok Chu Wong1, Jodhy Suk Ying Mak1, Adrian Wong2
1Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
Abstract:
Cognitive impairment is a major factor contributing to poor functional outcome after subarachnoid hemorrhage caused by a ruptured cerebral aneurysm (aSAH). Montreal Cognitive Assessment (MoCA) has been shown to be superior to the Mini-Mental State Examination in screening for cognitive domain deficit and correlating to functional outcome in aSAH patients. The aim of the current study was to determine the Montreal Cognitive Assessment (MoCA) score change that was associated with change of health in general in an aSAH patient cohort. We recruited aSAH patients from a regional neurosurgical center over a 3-year period. Patient assessments including MoCA and global rating of change (GRoC) were carried out at at 3 and 12months after aSAH. Anchor-based and distribution-based approaches were adopted to calculate the Minimum Clinically Important Difference (MID). One hundred and seventy-five aSAH patients completed both 3-month and 1-year assessments and consented for participation. Employing the distribution-based approach for the 3-month and 1-year MoCA scores, the MID estimates equated to a change of 2.0 and 1.1 respectively. Employing the anchor-based approach (with GRoC), the MID estimate of MoCA (median, IQR) was 2, 1-4. In conclusion, we found that the MID of MoCA score associated with change of health in general in aSAH patients was 2. The MID provides guidance for future clinical trial design targeting on cognitive dysfunction after aSAH.
Insights
A change of 2 points on the Montreal Cognitive Assessment (MoCA) signifies a meaningful improvement in general health for patients following subarachnoid hemorrhage (SAH). This finding is crucial for understanding recovery after brain aneurysm rupture.
Area of Science:
- Neurosurgery
- Neurology
- Cognitive Science
Background:
- Cognitive impairment significantly impacts functional outcomes in patients after subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysms.
- The Montreal Cognitive Assessment (MoCA) is more effective than the Mini-Mental State Examination for screening cognitive deficits and predicting functional outcomes in SAH patients.
Purpose of the Study:
- To determine the Minimum Clinically Important Difference (MID) in MoCA scores that corresponds to a general change in health for patients who have experienced SAH.
- To provide guidance for future clinical trial designs focused on cognitive dysfunction after SAH.
Main Methods:
- A cohort of 175 SAH patients were assessed at 3 and 12 months post-event.
- Assessments included the MoCA and a global rating of change (GRoC).
- Both anchor-based and distribution-based approaches were used to calculate the MoCA MID.
Main Results:
- Distribution-based approaches yielded MoCA MID estimates of 2.0 (3-month) and 1.1 (1-year).
- The anchor-based approach, using GRoC, resulted in a MoCA MID of 2 (median, IQR: 1-4).
- The study identified a consensus MID of 2 points for the MoCA score in relation to general health changes in SAH patients.
Conclusions:
- A 2-point increase in MoCA score represents a clinically meaningful improvement in general health for individuals recovering from SAH.
- This established MID serves as a valuable benchmark for interpreting cognitive changes and designing future clinical trials in the SAH population.
