MoCA most effective in screening cognitive impairment in SLE
Patients with systemic lupus erythematosus (SLE) are prone to have cognitive impairment (CI), and the Montreal Cognitive Assessment (MoCA) appears to be a useful tool for detecting CI in SLE, according to a recent study. In addition, CI is less likely to occur in patients with more years of education.
In this study, researchers sought to determine the prevalence of CI in SLE by the MoCA, Mini Mental State Examination (MMSE), in relation to the Hopkins Verbal Learning Test‒Revised (HVLT-R), and Perceived Deficits Questionnaire 5-Item (PDQ-5); and factors associated with CI.
A total of 98 consecutive patients followed at a single centre were recruited and administered MoCA, MMSE and HVLT-R. Sensitivity/specificity, positive (PPV)/negative (NPV) predictive values and positive likelihood ratio (LR+) of MoCA/MMSE were estimated (compared to HVLT-R). Participants also accomplished a test on intellectual ability and questionnaires on anxiety, depression and perceived cognitive deficits. Regression analyses were conducted to determine associations with CI.
Of the patients, 48 percent had CI using MoCA and 31 percent using HVLT-R. MoCA had higher sensitivity compared to MMSE (73 vs 27 percent), but MMSE was more specific than MoCA (90 vs 63 percent).
MoCA and MMSE had similar PPV (47 vs 53 percent, respectively) and LR+ (2.0 vs 2.6, respectively), but MoCA had higher NPV than MMSE (84 vs 74 percent). PDQ-5 predicted objective CI (HLVT-R: sensitivity, 100 percent; specificity, 89 percent).
Univariate analyses revealed that CI was associated with depression, but it did not hold in the multivariate analysis; longer SLE disease duration and more years of education remained significant.