Diagnostic accuracy of the Montreal Cognitive Assessment in screening for cognitive impairment in initially hospitalized COVID-19 patients: Findings from the prospective multicenter NeNeSCo study

Simona Klinkhammer, Esmee Verwijk, Gert Geurtsen, Annelien A. Duits, Georgios Matopoulos, Johanna M. A. Visser-Meily, Janneke Horn, Arjen J. C. Slooter, Caroline M. van Heugten*, NeNeSCo study group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: This study aimed to investigate the prevalence and nature of cognitive impairment among severely ill COVID-19 patients and the effectiveness of the Montreal Cognitive Assessment (MoCA) in detecting it. Method: We evaluated cognition in COVID-19 patients hospitalized during the first wave (March to June 2020) from six Dutch hospitals, nine months post-discharge, using a comprehensive multi-domain neuropsychological test battery. Test performance was corrected for sex, age, and education differences and transformed into z-scores. Scores within each cognitive domain were averaged and categorized as average and above (z-score >= - 0.84), low average (z-score - 1.28 to - 0.84), below average (z-score - 1.65 to - 1.28), and exceptionally low (z-score < - 1.65). Patients were classified with cognitive impairment if at least one domain's z-score fell below - 1.65. We assessed the MoCA's accuracy using both the original cutoff (<26) and an " optimal " cutoff determined by Youden's index. Results: Cognitive impairment was found in 12.1% (24/199) of patients, with verbal memory and mental speed most affected (6.5% and 7% below - 1.65, respectively). The MoCA had an area under the curve of 0.84. The original cutoff showed sensitivity of 83% and specificity of 66%. Using the identified optimal cutoff of < 24, maintained sensitivity while improving specificity to 81%. Conclusions: Cognitive impairment prevalence in initially hospitalized COVID-19 patients is lower than initially expected. Verbal memory and processing speed are primarily affected. The MoCA is a valuable screening tool for these impairments and lowering the MoCA cutoff to < 24 improves specificity.
Original languageEnglish
Number of pages8
JournalJournal of the International Neuropsychological Society
DOIs
Publication statusE-pub ahead of print - 3 Jan 2025

Keywords

  • Post-COVID-19
  • cognitive screening
  • validation
  • inflammatory
  • cognition
  • Montreal Cognitive Assessment
  • TOOL

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