TY - JOUR
TI - Screening for cognitive impairment in systemic lupus erythematosus:
Application of the Montreal Cognitive Assessment (MoCA) in a Greek
patient sample
AU - Papastefanakis, Emmanouil
AU - Dimitraki, Georgia
AU - Ktistaki, Georgia
AU - and Fanouriakis, Antonis
AU - Karamaouna, Penny
AU - Bardos, Achilles and
AU - Kallitsakis, Ioannis
AU - Adamichou, Christina
AU - Gergianaki, Irini and
AU - Repa, Argyro
AU - Bertsias, George
AU - Sidiropoulos, Prodromos and
AU - Karademas, Evangelos
AU - Simos, Panagiotis
JO - Lupus Science and Medicine
PY - 2021
VL - 30
TODO - 14
SP - 2237-2247
PB - SAGE Publications Ltd
SN - null
TODO - 10.1177/09612033211061062
TODO - Systemic lupus erythematosus; neuropsychiatric lupus; cognitive
impairment; Montreal Cognitive Assessment; neuropsychological test
battery
TODO - Background Cognitive impairment (CI) is one of the most frequent
neuropsychiatric manifestations of systemic lupus erythematosus (SLE).
Given that extensive neuropsychological testing is not always feasible
in routine clinical practice, brief cognitive screening tools are
desirable. The aim of this study was to evaluate the Montreal Cognitive
Assessment (MoCA) as a screening tool for CI in SLE. Methods Consecutive
SLE patients followed at a single centre were evaluated using MoCA and
an extensive neuropsychological test battery (NPT), including the Digits
Forward and Digits Backwards, Rey Auditory Verbal Learning Memory Test,
Trail Making Test, Stroop Colour-Word Test, Semantic and Phonetic Verbal
Fluency tests and a 25-problem version of the General Adult Mental
Ability test. The criterion validity of MoCA was assessed through
receiver operating characteristic (ROC) analyses using three different
case definitions: i) against normative population data, ii) and iii)
against average performance of a comparison group of rheumatoid
arthritis (RA) patients, to adjust for possible confounding effects of
chronic illness and inflammatory processes on cognitive performance. The
effect of patient-related (age, years of education, anxiety, depression,
fatigue and pain) and disease-related (activity, damage, age at
diagnosis, disease duration, use of glucocorticoid, psychotropic and
pain medication) parameters on the MoCA was examined. Results A total of
71 SLE patients were evaluated. MoCA significantly correlated with all
NPT scores and was affected by education level (p < 0.001), but not by
other demographic or clinical variables. The optimal cutoff for
detecting CI, as defined on the basis of normative population data, was
23/30 points, demonstrating 73% sensitivity and 75% specificity. A
cutoff of 22/30 points, using neuropsychological profiles of the RA
group as inflammatory disease controls, exhibited higher sensitivity
(100%, based on both definitions) and specificity (87% and 90%,
depending on the definition). The standard cutoff of 26/30 points
displayed excellent sensitivity (91-100%) with significant expenses in
specificity (43-45%). Conclusion The MoCA is an easily applied tool,
which appears to be reliable for identifying CI in SLE patients. The
standard cutoff score (26/30) ensures excellent sensitivity while lower
cutoff scores (22-23/30) may, also, provide higher specificity.
ER -