Introduction
Many patients with brain lesion experience cognitive impairments. The degree of cognitive decline is an important factor in determining quality of life of survivors. Therefore, accurate assessment is important for effective intervention of cognitive dysfunction. The Wechsler Adult Intelligence Scale, fourth edition (WAIS-IV) Full Scale Intelligence Quotient (FSIQ) enables detailed cognitive assessments; however due to time-consuming and poor cost-effectiveness, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are more widely used. The MoCA is known to be more sensitive in detecting mild cognitive impairment than MMSE. Visuospatial/execution domains of MoCA provide an advantage over the MMSE. In this study, we aim to compare the MMSE and MoCA with other measures of cognitive function including WAIS-IV.
Materials and Methods
This retrospective review was based on chart review of patients hospitalized for brain injury between February 2017 and February 2018. Inclusion criteria were as follows: 1) confirmed brain lesion on MRI, 2) subacute stage within 6 months after the onset. However, patients with 1) a history of previous brain injury, 2) neurodegenerative diseases such as Alzheimer’s dementia and Parkinson’s disease, 3) psychiatric comorbidities were excluded. Baseline cognitive function was assessed with following parameters: MMSE, MoCA, sub-indices of WAIS-IV; Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index, and Processing Speed Index, and FSIQ, Aphasia Quotient (AQ), Memory Quotient (MQ), Motor-Free Visual Perception Test-3 (MVPT-3), and Loewenstein Occupational Therapy Cognitive Assessment (LOTCA). Assessments of cognitive function, language, and visual perception were performed within one week after admission by psychotherapist, language therapist, and occupational therapist, respectively. Spearman’s correlation test was used on ordinal scale data. For statistical analysis, SPSS (IBM, version 21) was used.
Results
A total of 36 patients with brain lesion (right side 19, left side 13, and other lesions 4) were enrolled for the study as shown in Table 1. The MoCA showed higher correlation in all subtests of the IQ than MMSE. Interestingly, the visuospatial score of the MoCA showed significant correlation with PRI values in left brain injured patients (Figure, r=0.824, p=0.001). Both MMSE and MoCA scores correlated significantly with the MVPT-3 while AQ and LOTCA did not show any correlation with either measure.(Table 2 and 3)
Conclusion
The MoCA was associated with IQ subscores more than the MMSE in assessing the intellectual disability of patients with brain lesion. In addition, the advantage of MoCA over the MMSE in assessing the visuospatial function can be supportive in identifying defective domain of intelligence. Further study with larger sample size will be helpful to identify specific dysfunction of cognitive subdomains in patients with brain lesion. |
