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Montreal Cognitive Assessment 5-Minute Protocol Is a Brief, Valid, Reliable, and Feasible Cognitive Screen for Telephone Administration
- Adrian Wong, PhD,
- David Nyenhuis, PhD,
- Sandra E. Black, MD,
- Lorraine S.N. Law, BSocSc,
- Eugene S.K. Lo, BSocSc,
- Pauline W.L. Kwan, MSocSc,
- Lisa Au, MD,
- Anne Y.Y. Chan, MD,
- Lawrence K.S. Wong, MD,
- Ziad Nasreddine, MD and
- Vincent Mok, MD
+ Author Affiliations
- Correspondence to Vincent Mok, MD, Department of Medicine and Therapeutics, 9/F Clinical Sciences Bldg, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China. E-mail vctmok@cuhk.edu.hk
Abstract
Background and Purpose—The
National Institute of Neurological Disorders and Stroke-Canadian Stroke
Network Vascular Cognitive Impairment Harmonization
working group proposed a brief cognitive
protocol for screening of vascular cognitive impairment. We investigated
the validity,
reliability, and feasibility of the Montreal
Cognitive Assessment 5-minute protocol (MoCA 5-minute protocol)
administered
over the telephone.
Methods—Four items
examining attention, verbal learning and memory, executive
functions/language, and orientation were extracted from
the MoCA to form the MoCA 5-minute protocol.
One hundred four patients with stroke or transient ischemic attack,
including
53 with normal cognition (Clinical Dementia
Rating, 0) and 51 with cognitive impairment (Clinical Dementia Rating,
0.5 or
1), were administered the MoCA in clinic and a
month later, the MoCA 5-minute protocol over the telephone.
Results—Administration of the MoCA 5-minute protocol took 5 minutes over the telephone. Total score of the MoCA 5-minute protocol
correlated negatively with age (r=−0.36; P<0.001) and positively with years of education (r=0.41; P<0.001) but not with sex (ρ=0.03; P=0.773). Total scores of the MoCA and MoCA 5-minute protocol were highly correlated (r=0.87; P<0.001).
The MoCA 5-minute protocol performed equally well as the MoCA in
differentiating patients with cognitive impairment
from those without (areas under receiver
operating characteristics curve for MoCA 5-minute protocol, 0.78;
MoCA=0.74; P>0.05 for difference; Cohen d for group difference, 0.80–1.13). It differentiated cognitively impaired patients with executive domain impairment from those
without (areas under receiver operating characteristics curve, 0.89; P<0.001; Cohen d=1.7 for group difference). Thirty-day test–retest reliability was excellent (intraclass correlation coefficient, 0.89).
Conclusions—The MoCA 5-minute protocol is a free, valid, and reliable cognitive screen for stroke and transient ischemic attack. It is
brief and highly feasible for telephone administration.
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