(41) Screening for Brain Fog: Is the Montreal Cognitive Assessment an Effective Screening Tool for Neurocognitive complaints Post-COVID-19?

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

2022

DOI

10.1016/j.jaclp.2022.10.044

Journal Title

Journal of the Academy of Consultation-Liaison Psychiatry

Department

Psychiatry and Behavioral Sciences

Second Department

Surgery

Abstract

Background: The SARS-CoV-2 virus has infected over 20 million people worldwide, and while much about the virus remains uncertain, it is evident that long-term effects of COVID-19 infection have affected a significant portion of survivors. Prior studies have shown neurocognitive complaints from long-term sequelae of the virus, which co-occur frequently with psychiatric symptoms of depression, anxiety, and fatigue. This group has previously published on neuropsychiatric findings from an assessment of 60 participants who’ve recovered from acute COVID-19, and showed that 27% had impairment on neuropsychological (NP) testing. Since many survivors of COVID have these complaints, it is important to determine if any sort of screening tool is able to detect neurocognitive impairments. The authors chose to use the Montreal Cognitive Assessment due to ease of use, availability, and prior studies. We aimed to determine if the MoCA was sensitive and specific for detecting neurocognitive impairment post-COVID-19. Methods: This study looked at a sample of 60 participants who had recovered from acute COVID-19, recruited primarily from Westchester County, New York. Participants underwent a neuropsychological testing battery, as well as sociodemographic, psychiatric, and medical screenings, in addition to completing the MoCA. Results: Over one third of the participants scored as impaired (< 26) on the MoCA, with Delayed Recall being the subcategory most impaired. MoCA score was significantly correlated with the Chalder Fatigue score and PHQ-9. Based on results from the neuropsychological testing battery, we found that the MoCA had an accuracy of 63.3% at detecting any NP impairment, with a sensitivity of 50.0% and specificity of 83.3%. However, it had an accuracy of 73.3% at detecting severe NP impairment, and was 68.8% sensitive and 75.0% specific. In a logistic regression model we found that the MoCA was the most significant predictor of severe NP impairment, and that for each unit increase in Total MoCA score, the odds of severe NP impairment decreased by 47%. Discussion: We found that the MoCA was effective at detecting severe NP impairment at patients who have recovered from acute COVID-19 infection, however it was not very sensitive at detecting mild NP impairment. Despite this, the MoCA was the most significant predictor of severe NP impairment. The authors conclude that the MoCA is an important first step in identifying cognitive impairment in patients post-COVID-19, however, if a patient has cognitive complaints and a normal MoCA score, it may still warrant further NP testing.

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