TY - JOUR
T1 - Diagnostic accuracy of the Montreal Cognitive Assessment in screening for cognitive impairment in initially hospitalized COVID-19 patients
T2 - Findings from the prospective multicenter NeNeSCo study
AU - Klinkhammer, Simona
AU - Verwijk, Esmee
AU - Geurtsen, Gert
AU - Duits, Annelien A.
AU - Matopoulos, Georgios
AU - Visser-Meily, Johanna M. A.
AU - Horn, Janneke
AU - Slooter, Arjen J. C.
AU - van Heugten, Caroline M.
AU - NeNeSCo study group
PY - 2025/1/3
Y1 - 2025/1/3
N2 - 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.
AB - 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.
KW - Post-COVID-19
KW - cognitive screening
KW - validation
KW - inflammatory
KW - cognition
KW - Montreal Cognitive Assessment
KW - TOOL
U2 - 10.1017/S1355617724000675
DO - 10.1017/S1355617724000675
M3 - Article
SN - 1355-6177
JO - Journal of the International Neuropsychological Society
JF - Journal of the International Neuropsychological Society
ER -