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Abstract Number: 1650

The Montreal Cognitive Assessment Questionnaire (MoCA): A Promising Screening Tool for Cognitive Dysfunction in SLE

Nathalie Chalhoub and Michael Luggen, Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, OH

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Cognitive dysfunction and systemic lupus erythematosus (SLE)

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Session Information

Date: Monday, November 6, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Cognitive dysfunction (CD) is among the most common neuropsychiatric manifestations in SLE. However, the diagnosis is oftentimes delayed and occasionally overlooked because of the lack of a sensitive and practical screening test. Several methods have been used to ascertain CD in patients with SLE, including traditional neuropsychological testing (NPT) and the Automated Neuropsychologic Assessment Metrics (ANAM), a computerized battery of symbol based tests measuring many of the same cognitive domains as NPT. Both are time-consuming, relatively costly, and not readily available. The Montreal Cognitive Assessment Questionnaire (MoCA) is a one-page performance-based screening test that has been validated to identify mild cognitive impairment in the elderly and, in preliminary work done by us, appeared to hold promise in SLE as well. This study aims to further evaluate the MoCA as a screening tool for the diagnosis of CD in SLE.

Methods: Patients with SLE fulfilling the American College of Rheumatology criteria were recruited. All subjects were administered the ANAM test and the MoCA questionnaire. MoCA scores were compared to the total throughput score (TTS) (correct responses/time for the responses), a standard measure of performance of the ANAM. Individual MoCA questions were also compared to TTS to identify the MoCA questions with the strongest correlation with CD. The classification of normal or abnormal by the ANAM was compared to that of the MoCA using various cutoffs. Sensitivity, specificity, likelihood ratios and predictive values were also computed at the various cut-offs for the MoCA.

Results: In total, 74 patients were evaluated. Of these, 15 (20 %) were identified by the ANAM as having cognitive dysfunction in comparison with 33 (44.6 %) by the MoCA using the standard cutoff of 26. The scores were significantly correlated (r= 0.51, p <0.001). Six out of the 10  MoCA questions showed significant correlation with the ANAM score with the assessment of visuospatial and executive function being the most highly correlated with CD (p= 0.000199). Using the standard cutoff of 26, the sensitivity of the MoCA was 93%, specificity 68%, and negative predictive value 98%. All other cut-offs were inferior.

Conclusion: The MoCA appears to be a promising and practical screening tool for identification of patients with SLE at risk for cognitive dysfunction.

Table 1.  MoCA Performance Characteristics

Cutoff

Sensitivity

Specificity

LR+a

LR-b

PPVc

NPVd

24

0.6

0.81

3.16

0.49

0.45

0.89

25

0.73

0.75

2.92

0.36

0.42

0.92

26

0.93

0.68

2.9

0.10

0.42

0.98

27

0.93

0.47

1.75

0.15

0.31

0.97

28

1

0.25

1.33

0

0.25

1

aPositive likelihood ratio

bNegative likelihood ratio

cPositive predictive value

dNegative predictive value

 


Disclosure: N. Chalhoub, None; M. Luggen, None.

To cite this abstract in AMA style:

Chalhoub N, Luggen M. The Montreal Cognitive Assessment Questionnaire (MoCA): A Promising Screening Tool for Cognitive Dysfunction in SLE [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-montreal-cognitive-assessment-questionnaire-moca-a-promising-screening-tool-for-cognitive-dysfunction-in-sle/. Accessed .
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