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

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.