Use of Montreal Cognitive Assessment (MoCA) for early diagnosis of cognitive disorders in patients with multiple sclerosis

November 4, 2024
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Resume

Multiple sclerosis (MS) is characterized by neuroinflammation of the central nervous system, which gradually leads to demyelination, axonal loss, and neurodegeneration, which in turn leads to volume loss. MS mainly affects the young working population and is a socio-economically significant disease. Cognitive impairment develops in approximately 40–70% of patients. Violation of memory, speed of information processing, attention, executive functions can be manifested already in the early stages of the disease. The presence of cognitive deficits at the time of MS diagnosis is considered a marker of unfavorable prognosis. Therefore, it is necessary to have a short reliable test to assess cognitive status.

The purpose of the study: to analyze the existing tests used for the diagnosis of cognitive disorders in patients with MS, to evaluate their effectiveness, accessibility for patients and medical personnel, to determine potential factors influencing the indicators of cognitive functions. When screening and monitoring cognitive impairment, it is important to consider the impact of the following factors: fatigue, depression, anxiety, sleep disorders, general physical disability, and side effects of medications. Studies show that long-term testing requires significant medical resources and is exhausting for the patient. That is why the search for the optimal screening test for routine use continues.

Conclusion. Early detection of cognitive impairment is of primary importance. The MoCA, on par with other short tests (such as the SDMT), allows for quick and effective detection of cognitive impairment in patients with MS, simplifying their diagnosis and facilitating timely referral to a more in-depth neuropsychological assessment and can be recommended for use in outpatient settings.

References

  • 1. Geloso M.C., D’Ambrosi N. (2021) Microglial Pruning: Relevance for Synaptic Dysfunction in Multiple Sclerosis and Related Experimental Models. Cells, 10(3): 686. doi: 10.3390/cells10030686.
  • 2. Manjaly Z.M., Harrison N.A., Critchley H.D. et al. (2019) Pathophysiological and cognitive mechanisms of fatigue in multiple sclerosis. J. Neurol. Neurosurg. Psychiatr., 90(6): 642–651. doi: 10.1136/jnnp-2018-320050.
  • 3. Trenova A.G., Slavov G.S., Manova M.G. et al. (2016) Cognitive Impairment in Multiple Sclerosis. Folia Med (Plovdiv)., 58(3): 157–163. doi: 10.1515/folmed-2016-0029.
  • 4. Sumowski J.F., Leavitt V.M., Rocca M.A. et al. (2018) Mesial temporal lobe and subcortical grey matter volumes differentially predict memory across stages of multiple sclerosis. Mult Scler., 24(5): 675–678. doi: 10.1177/1352458517708873.
  • 5. Lakin L., Davis B.E., Binns C.C. et al. (2021) Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms-A Narrative Review. Neurol. Ther., 10(1): 75–98. doi: 10.1007/s40120-021-00239-2.
  • 6. Walton C., King R., Rechtman L. et al. (2020) Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Mult. Scler., 26(14): 1816–1821. doi: 10.1177/1352458520970841.
  • 7. Bass A.D., Van Wijmeersch B., Mayer L. et al. (2020) Effect of Multiple Sclerosis on Daily Activities, Emotional Well-being, and Relationships: The Global vsMS Survey. Int. J. MS Care, 22(4): 158–164. doi: 10.7224/1537-2073.2018-087.
  • 8. Clemens L., Langdon D. (2018) How does cognition relate to employment in multiple sclerosis? A systematic review. Mult. Scler. Relat. Disord., 26: 183–191. doi: 10.1016/j.msard.2018.09.018.
  • 9. Di Filippo M., Portaccio E., Mancini A., Calabresi P. (2018) Multiple sclerosis and cognition: synaptic failure and network dysfunction. Nat. Rev. Neurosci., 19(10): 599–609. doi: 10.1038/s41583-018-0053-9.
  • 10. Maltby V.E., Lea R.A., Reeves P. et al. (2022) Reduced cognitive function contributes to economic burden of multiple sclerosis. Mult. Scler. Relat. Disord., 60: 103707. doi: 10.1016/j.msard.2022.103707.
  • 11. Gaetani L., Salvadori N., Chipi E. et al. (2021) Cognitive impairment in multiple sclerosis: lessons from cerebrospinal fluid biomarkers. Neural. Regen. Res., 16(1): 36–42. doi: 10.4103/1673-5374.286949.
  • 12. Charest K., Tremblay A., Langlois R. et al. (2020) Detecting Subtle Cognitive Impairment in Multiple Sclerosis with the Montreal Cognitive Assessment. Can. J. Neurol. Sci., 47(5): 620–626. doi: 10.1017/cjn.2020.97.
  • 13. Meca-Lallana V., Gascón-Giménez F., Ginestal-López R.C. et al. (2021) Cognitive impairment in multiple sclerosis: diagnosis and monitoring. Neurol. Sci., 42(12): 5183–5193. doi: 10.1007/s10072-021-05165-7.
  • 14. Lisak M., Špiljak B., Pašić H., Trkanjec Z. (2021) Cognitive Aspects in Multiple Sclerosis. Psychiatr. Danub., 33(Suppl. 13): 177–182.
  • 15. Labiano-Fontcuberta A., Martínez-Ginés M.L., Aladro Y. et al. (2016) A comparison study of cognitive deficits in radiologically and clinically isolated syndromes. Mult. Scler., 22(2): 250–253. doi: 10.1177/1352458515591072.
  • 16. McNicholas N., O’Connell K., Yap S.M. et al. (2018) Cognitive dysfunction in early multiple sclerosis: a review. QJM, 111(6): 359–364. doi: 10.1093/qjmed/hcx070.
  • 17. Thelen J.M., Lynch S.G., Bruce A.S. et al. (2014) Polypharmacy in multiple sclerosis: relationship with fatigue, perceived cognition, and objective cognitive performance. J. Psychosom. Res., 76(5): 400–404. doi: 10.1016/j.jpsychores.2014.02.013.
  • 18. Lechner-Scott J., Agland S., Allan M. et al. (2023) Managing cognitive impairment and its impact in multiple sclerosis: An Australian multidisciplinary perspective. Mult. Scler. Relat. Disord., 79: 104952. doi: 10.1016/j.msard.2023.104952.
  • 19. Gill S., Santo J., Blair M., Morrow S.A. (2019) Depressive Symptoms Are Associated With More Negative Functional Outcomes Than Anxiety Symptoms in Persons With Multiple Sclerosis. J. Neuropsychiatr. Clin. Neurosci., 31(1): 37–42. doi: 10.1176/appi.neuropsych.18010011.
  • 20. Weinstock-Guttman B., Jacobs L.D., Brownscheidle C.M. et al. (2003) Multiple sclerosis characteristics in African American patients in the New York State Multiple Sclerosis Consortium. Mult. Scler., 9(3): 293–298. doi: 10.1191/1352458503ms909oa.
  • 21. Sandi D., Biernacki T., Szekeres D. et al. (2017) Prevalence of cognitive impairment among Hungarian patients with relapsing-remitting multiple sclerosis and clinically isolated syndrome. Mult. Scler. Relat. Disord., 17: 57–62. doi: 10.1016/j.msard.2017.06.017.
  • 22. Oset M., Stasiolek M., Matysiak M. (2020) Cognitive Dysfunction in the Early Stages of Multiple Sclerosis-How Much and How Important? Curr. Neurol. Neurosci. Rep., 20(7): 22. doi: 10.1007/s11910-020-01045-3.
  • 23. Migliore S., Ghazaryan A., Simonelli I. et al. (2017) Cognitive Impairment in Relapsing-Remitting Multiple Sclerosis Patients with Very Mild Clinical Disability. Behav. Neurol., 2017: 7404289. doi: 10.1155/2017/7404289.
  • 24. Odintsova T. (2021) Characteristics of cognitive impairment in multiple sclerosis patients depending on different risk factors. Psychiatr. Neurol. Med. Psychol., 18: 39–48. doi: 10.26565/2312-5675-2021-18-03.
  • 25. Sabanagic-Hajric S., Memic-Serdarevic A., Sulejmanpasic G. et al. (2023) Cognitive Imapirment in Multiple Sclerosis: Relation to Dysability, Duration and Type of Disease. Mater. Sociomed., 35(1): 23–27. doi: 10.5455/msm.2023.35.23-27.
  • 26. Miller E., Morel A., Redlicka J. et al. (2018) Pharmacological and Non-pharmacological Therapies of Cognitive Impairment in Multiple Sclerosis. Curr. Neuropharmacol., 16(4): 475–483. doi: 10.2174/1570159X15666171109132650.
  • 27. Van Schependom J., D’hooghe M.B., Cleynhens K. et al. (2014) The Symbol Digit Modalities Test as sentinel test for cognitive impairment in multiple sclerosis. Eur. J. Neurol., 21(9): 1219-e72. doi: 10.1111/ene.12463.
  • 28. Jia X., Wang Z., Huang F. et al. (2021) A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study. BMC Psychiatr., 21(1): 485. doi: 10.1186/s12888-021-03495-6.
  • 29. Arab Ahmadi M., Ashrafi F., Behnam B. (2016) Comparison of Montreal Cognitive Assessment test and Mini Mental State Examination in detecting cognitive impairment in relapsing-remitting multiple sclerosis patients. Int. Clin. Neurosci. J., 2(4): 137–141. doi.org/10.22037/icnj.v2i4.11665.
  • 30. Benedict R.H., DeLuca J., Phillips G. et al. (2017) Validity of the Symbol Digit Modalities Test as a cognition performance outcome measure for multiple sclerosis. Mult. Scler., 23(5): 721–733. doi: 10.1177/1352458517690821.
  • 31. Al-Falaki T.A., Hamdan F.B., Sheaheed N.M. (2021) Assessment of cognitive functions in patients with multiple sclerosis. Egypt. J. Neurol. Psychiatr. Neurosurg., 57(1): 127. doi: 10.1186/s41983-021-00383-4.
  • 32. Davion J.B., Lopes R., Jougleux C. et al. (2022) Brief International Cognitive Assessment for Multiple Sclerosis scores are associated with the cortical thickness of specific cortical areas in relapsing-remitting patients. Rev. Neurol. (Paris), 178(4): 326–336. doi: 10.1016/j.neurol.2021.06.014.
  • 33. Kalb R., Beier M., Benedict R.H. et al. (2018) Recommendations for cognitive screening and management in multiple sclerosis care. Mult. Scler., 24(13): 1665–1680. doi: 10.1177/1352458518803785.
  • 34. Cortés-Martínez A., Matias-Guiu J.A., Pytel V. et al. (2019) What is the meaning of PASAT rejection in multiple sclerosis?. Acta Neurol. Scand., 139(6): 559–562. doi: 10.1111/ane.13090.
  • 35. Sehanovic A., Smajlovic D., Tupkovic E. et al. (2020) Cognitive Disorders in Patients with Multiple Sclerosis. Mater. Sociomed., 32(3): 191–195. doi: 10.5455/msm.2020.32.191-195.
  • 36. Freitas S., Batista S., Afonso A.C. et al. (2018) The Montreal Cognitive Assessment (MoCA) as a screening test for cognitive dysfunction in multiple sclerosis. Appl. Neuropsychol. Adult., 25(1): 57–70. doi: 10.1080/23279095.2016.1243108.
  • 37. Gomez-Moreno S.M., Cuadrado M.L., Cruz-Orduña I. et al. (2022) Validation of the Spanish-language version of the Montreal Cognitive Assessment as a screening test for cognitive impairment in multiple sclerosis. Neurologia (Engl. Ed.), 37(9): 726–734. doi: 10.1016/j.nrleng.2019.11.007.
  • 38. Botchorishvili N., Shiukashvili N., Mikeladze N. et al. (2021) Screening of Cognitive Impairment in Patients with Multiple Sclerosis: A Cross-Sectional Study in Georgia. Neurol. Res. Int., 2021: 5591078. doi: 10.1155/2021/5591078.
  • 39. Vogel S.J., Banks S.J., Cummings J.L., Miller J.B. (2015) Concordance of the Montreal cognitive assessment with standard neuropsychological measures. Alzheimers Dement. (Amst), 1(3): 289–294. doi: 10.1016/j.dadm.2015.05.002.
  • 40. Kaur D., Kumar G., Singh A.K. (2013) Quick screening of cognitive function in Indian multiple sclerosis patients using Montreal cognitive assessment test-short version. Ann. Indian Acad. Neurol., 16(4): 585–589. doi: 10.4103/0972-2327.120478.
  • 41. Charvet L.E., Taub E., Cersosimo B.H. et al. (2015) The Montreal Cognitive Assessment (MoCA) in Multiple Sclerosis: Relation to Clinical Features. J. Multiple Scler., 2: 1–6. doi: 10.4172/2376-0389.1000135.