MoCA as a screening tool for MND in PLWHIV
Research type
Research Study
Full title
The Montreal Cognitive Assessment as a Screening tool for Mild Neurocognitive Disorder in People Living With HIV
IRAS ID
318899
Contact name
Clara O'Brien
Contact email
Sponsor organisation
University Hospitals Sussex NHS Foundation Trust
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
0 years, 2 months, 4 days
Research summary
This study is investigating whether the Montreal Cognitive Assessment (MoCA) is a suitable screening tool for identifying cognitive impairments in people living with HIV, using the DSM-V criteria for cognitive impairment. This research aims to improve clinical practice in HIV services and ensure that all those who are experiencing cognitive difficulties are being identified for further testing by the screening tool.
There will be two subsamples within this study. Subsample A will include all individuals who have already attended the Orange Clinic, which is a memory clinic in Brighton, and has completed a battery of neuropsychological tests as part of their care. Therefore, Subsample A will consist of pre-existing data that is stored by the Orange Clinic on the University Hospitals Sussex NHS Foundation Trust's system.
Subsample B will consist of 30 recruited participants. They will be recruited from the Lawson Unit, a sexual health clinic in Brighton (of which the Orange Clinic is a part of). All the participants will have a diagnosis of HIV, and have scored above 26 on the MoCA (26 or below being the employed clinical cut-off for further neuropsychological testing). The rationale for collecting this new data is that the pre-existing dataset mentioned above will not include neuropsychological assessments for participants in the non-clinical range on the MoCA, which is required for the statistical analysis (probability of false negative). These participants will be invited to complete further neuropsychological testing, which will take approximately 60-90 minutes.
The data from both subsamples will collated to form one sample, which will be analysed using a single Receiver Operating Characteristic analysis.
The study will also examine whether the MoCA questions that are designed to test particular cognitive domains correlate with the cognitive domains aimed to be tested by the neuropsychological tests. This will be analysed using Pearson correlation.
Summary of results
The research had two aims. The first aim was to evaluate the suitability of the Montreal Cognitive Assessment (MoCA) for people with neurocognitive disorder due to HIV. The second aim was to compare the screening tool with the full battery of neuropsychological testing.
The analysis found that the MoCA had “good” ability at identifying those with and without HAND, according to analysis interpretation guidelines. The analysis suggested the cut-off score of below 25 would be best for identifying those who need further testing. It should be noted that no screening tools are perfect, and there will be people who have cognitive impairments who may not be identified using the MoCA. Therefore, this should be carefully considered by services who are using screening tools.
As both the MoCA and the neuropsychological tests aim to measure specific cognitive constructs, such as memory, and attention, the researchers also explored whether there was a correlation between the subscale scores on the MoCA (e.g. attention, delayed memory, language) and the subtests that measure the same construct. The MoCA subscale scores were all found to correlate with the scores of several different subtest scores. This suggests that the MoCA subtest scores may not be very specific in the construct that they are measuring. Therefore, the overall MoCA score may be a better implication of a person’s cognitive ability and clinicians should not draw conclusions from the subscale scores from the MoCA. This may be due to the brief nature of the test which is necessary in a screening tool.
The research has been useful in evaluating the MoCA with a specific criteria for HIV-related neurocognitive disorder, which has not been explored before. The results support the MoCA as a screening tool for people with mild or major neurocognitive disorders due to HIV. The MoCA itself is not accurate enough or in-depth enough to be classed as a diagnostic tool in itself and should only be used to identify those who may require further neuropsychological testing.REC name
London - Bromley Research Ethics Committee
REC reference
24/LO/0140
Date of REC Opinion
8 Mar 2024
REC opinion
Further Information Favourable Opinion