Diagnostic accuracy of the Montreal Cognitive Assessment in screening for cognitive impairment in initially hospitalized COVID-19 patients: Findings from the prospective multicenter NeNeSCo study.
Simona Klinkhammer, Esmée Verwijk, Gert Geurtsen, Annelien A Duits, Georgios Matopoulos, Johanna M A Visser-Meily, Janneke Horn, Arjen J C Slooter, Caroline M van Heugten, NeNeSCo study group
Author Information
Simona Klinkhammer: School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands. ORCID
Esmée Verwijk: Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, Netherlands.
Gert Geurtsen: Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, Netherlands.
Annelien A Duits: School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands.
Georgios Matopoulos: School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands.
Johanna M A Visser-Meily: Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, Netherlands.
Janneke Horn: Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, Netherlands.
Arjen J C Slooter: UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands.
Caroline M van Heugten: School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands.
OBJECTIVE: This study aimed to investigate the prevalence and nature of Cognitive impairment among severely ill COVID-19patients and the effectiveness of the Montreal Cognitive Assessment (MoCA) in detecting it. METHOD: We evaluated cognition in COVID-19patients hospitalized during the first wave (March to June 2020) from six Dutch hospitals, nine months post-discharge, using a comprehensive multi-domain neuropsychological test battery. Test performance was corrected for sex, age, and education differences and transformed into -scores. Scores within each cognitive domain were averaged and categorized as average and above (-score ≥ -0.84), low average (-score -1.28 to 0.84), below average (-score -1.65 to -1.28), and exceptionally low (-score < -1.65). patients were classified with Cognitive impairment if at least one domain's -score fell below -1.65. We assessed the MoCA's accuracy using both the original cutoff (<26) and an "optimal" cutoff determined by Youden's index. RESULTS: Cognitive impairment was found in 12.1% (24/199) of patients, with verbal memory and mental speed most affected (6.5% and 7% below -1.65, respectively). The MoCA had an area under the curve of 0.84. The original cutoff showed sensitivity of 83% and specificity of 66%. Using the identified optimal cutoff of <24, maintained sensitivity while improving specificity to 81%. CONCLUSIONS: Cognitive impairment prevalence in initially hospitalized COVID-19patients is lower than initially expected. Verbal memory and processing speed are primarily affected. The MoCA is a valuable screening tool for these impairments and lowering the MoCA cutoff to <24 improves specificity.
