Temporal stability and responsiveness of the Montreal Cognitive Assessment following acquired brain injury

Abstract

Objectives: To evaluate the temporal stability and responsiveness of the Montreal Cognitive Assessment (MoCA) in acquired brain injury (ABI).

Research design and methods: English-speaking adults with stroke or moderate-to-severe traumatic brain injury were administered alternate forms of the MoCA (version 1, then 2), 6 weeks apart. Chronic group participants (n = 40) were community-dwelling, at least 1 year post-ABI (mean = 12.1 years, SD = 9.0), and presumed clinically stable. Sub-acute group participants (n = 36) were 30.8 days post-ABI (SD = 12.4) and were undergoing intensive rehabilitation. Individuals with an unstable medical or psychiatric condition or severe receptive aphasia were not eligible.

Results: The chronic group scored 21.6 (SD = 4.5) initially and 22.7 (SD = 3.8) on the second administration, demonstrating a small but significant practise effect (p = 0.009). The Pearson test–re-test correlation coefficient was 0.83. Using reliable change methodology in the chronic group, the 80% confidence interval (CI) for change across the two administrations was −2 to +4, adjusting for practise. Applied to the sub-acute group, 39% improved and 0% declined.

Conclusions: The MoCA is a brief standardized tool that appears useful for monitoring cognitive change after ABI. The findings enable clinicians to detect statistically reliable change across serial MoCA administrations in individuals with an ABI.

• Brain injuries
• cognition disorders
• neuropsychological tests
• psychometrics
• stroke

Acknowledgements

We would like to thank Dr. Jennifer Yao (physiatrist), Dr. David Koo (physiatrist) and John Tran (research assistant) for their contributions to this research project.

Declaration of interest

Financial support was gratefully received from the B.C. Rehab Foundation through its Research and Innovation Fund (Project Grant #20R67148). GLI has been reimbursed by the government, professional scientific bodies and commercial organizations for discussing or presenting research relating to traumatic brain injury (TBI) and sport-related concussion at meetings, scientific conferences and symposiums. He has a clinical practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including athletes). He has received honorariums for serving on research panels that provide scientific peer review of programmes. He is a co-investigator, collaborator or consultant on grants relating to mild TBI funded by several organizations. He has received research support from test publishing companies in the past, including ImPACT® Applications Systems (not in the past 5 years). The other authors have no conflicts of interest to report.