3 AC&R Study Summaries: MoCA Screening in SLE, Pediatric Social Disadvantages & Surgical Weight Loss Interventions

MoCA as a Screening Test in SLE

Assessing the utility of the Montreal Cognitive Assessment (MoCA)

By Oshrat E. Tayer-Shifman, MD, Kimberley Yuen, BSc, MD, & Zahi Touma, MD, PhD, FACP, FACR

Why was this study done? Cognitive impairment is a common manifestation of systemic lupus erythematosus (SLE), with a prevalence of 40% based on objective measures. The ACR Neuropsychological Battery (ACR-NB) is the gold standard test for cognitive impairment screening and diagnosis in adult SLE patients; however, it is not widely available. The Montreal Cognitive Assessment (MoCA) was developed to screen for neurocognitive disorder in the older population, but no evidence exists of its validity to accurately identify cognitive impairment in patients with SLE. We studied the utility of the MoCA as a screening test for cognitive impairment compared with the ACR-NB.

What were the study methods? Two hundred and eighty-five adults with SLE were administered the ACR-NB and the MoCA. For the ACR-NB, patients were classified as cognitively impaired with a z-score of ≤-1.5 in two or more domains. The area under the curve (AUC) and sensitivities/specificities were determined. A discriminant function analysis was also applied.

What were the key findings? Cognitive impairment was not accurately identified by the MoCA, compared with the ACR-NB (AUC of 0.66). Sensitivity and specificity were poor, at 50% and 69%, respectively for the MoCA recommended cutoff of 26, and 80% and 45%, respectively for a higher cutoff of 28. The discriminant function analysis demonstrated low ability of the MoCA to identify different cognitive impairment status.

What were the main conclusions? This large study evaluated the MoCA as a screening test for cognitive impairment in patients with SLE. Compared with the ACR-NB, the MoCA failed to show the sensitivity and specificity needed.

What are the implications for patients and clinicians? When screening for cognitive impairment in patients with SLE, the healthcare team should use a test that has evidence for validity in SLE. The MoCA can neither diagnose cog­nitive impairment nor rule out cognitive impairment in patients with SLE. The low specificity of the MoCA may lead to overdiagnosis and concern among patients. We have shown in a previous work that the Automated Neuro­psychological Assessment Metrics (ANAM) can be used to screen for cognitive impairment in SLE.¹

The study: Tayer-Shifman OE, Yuen K, Green R et al. Assessing the utility of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment in patients with systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2022 Jun 22. Online ahead of print.