Assessing the Utility of the Montreal Cognitive Assessment in Screening for Cognitive Impairment in Patients With Systemic Lupus Erythematosus

Oshrat E. Tayer-Shifman, Kimberley Yuen, Robin Green, Mahta Kakvan, Patricia Katz, Kathleen S. Bingham, Juan Pablo Diaz-Martinez, Lesley Ruttan, Joan E. Wither, Maria Carmela Tartaglia, Jiandong Su, Dennisse Bonilla, May Y. Choi, Simone Appenzeller, Michelle Barraclough, Dorcas E. Beaton, Zahi Touma*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objective: Screening for cognitive impairment (CI) in systemic lupus erythematosus (SLE) relies on the American College of Rheumatology (ACR) neuropsychological battery (NB). By studying the concurrent criterion validity, our goal was to assess the Montreal Cognitive Assessment (MoCA) as a screening tool for CI compared to the ACR-NB and to evaluate the added value of the MoCA to the Automated Neuropsychological Assessment Metrics (ANAM). Methods: A total of 285 adult SLE patients were administered the ACR-NB, MoCA, and ANAM. For the ACR-NB, patients were classified as having CI if there was a Z score of ≤–1.5 in ≥2 domains. The area under the curve (AUC) and sensitivities/specificities were determined. A discriminant function analysis was applied to assess the ability of the MoCA to differentiate between CI, undetermined CI, and non-CI patients. Results: CI was not accurately identified by the MoCA compared to the ACR-NB (AUC of 0.66). Sensitivity and specificity were poor at 50% and 69%, respectively, for the cutoff of 26, and 80% and 45%, respectively, for the cutoff of 28. The MoCA had a low ability to identify CI status. The addition of the MoCA to the ANAM led to improvement on the AUC by only 2.5%. Conclusion: The MoCA does not have adequate concurrent criterion validity to accurately identify CI in patients with SLE. The low specificity of the MoCA may lead to overdiagnosis and concern among patients. Adding the MoCA to the ANAM does not substantially improve the accuracy of the ANAM. These results do not support using the MoCA as a screening tool for CI in patients with SLE.

Original languageEnglish
Pages (from-to)569-577
Number of pages9
JournalArthritis Care and Research
Volume75
Issue number3
DOIs
StatePublished - Mar 2023

Funding

FundersFunder number
Bozzo family
Lou and Marissa Rocca family
Lupus Ontario
Schroeder Arthritis Institute
Stacey and Mark Krembil family
Pfizer
Lupus Research Alliance
Canadian Institutes of Health Research
Arthritis Society
Department of Medicine, University of Toronto

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