Montreal Cognitive Assessment May Be an Appropriate Tool To Assess Cognitive Dysfunction in Heart Failure

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Heart Failure (HF) patients have twice the risk of having cognitive deficit (CD) than the general population that may impact adherence to self-care. CD in HF is subtle and reversible, yet cognitive screening is not routinely performed due to lack of a simple screening tool. The purpose of the study was to compare the Montreal Cognitive Assessment (MoCA) and the Mini Mental Status Examination (MMSE) regarding their reliability and appropriateness to measure CD in HF, and to validate both against physiologic measures of cerebral perfusion. A cross sectional study enrolled ninety community dwelling adults aged 50 and above with HF. Participants were administered the MMSE and MoCA, questionnaires to measure co-morbidity, depression, disability, and completed a six-minute walk test. Clinical and demographic data were collected via questionnaire. Cerebral perfusion pressure was measured via transcranial doppler and cardiac index via impedance cardiograph. Most participants were men (66%), Caucasian (78%), aged 50 to 89 (62 ± 9 years), 80% were in AHA/ACC stage C, and 77% had ejection fraction <40%. The MoCA identified 54% participants with mild cognitive impairment and 17% with moderate cognitive impairment compared to 2.2% by the MMSE.

Descriptive statistics for MoCA & MMSE

The results confirm findings of researchers that the MMSE is not sensitive to identify subtle cognitive changes in HF. The MoCA identified similar pattern of CD in specific neuropsychological domains reported throughout HF literature.

Domains of MoCA with low Scores

The MoCA demonstrated a sensitivity of 96% and specificity of 78% for cutoff score<22 with an area under the ROC curve of 0.804. Despite the MoCA being able to identify subtle cognitive changes, the data did not demonstrate a relationship between CD and cerebral perfusion among the study participants, hence, unable to use for validation. However, Chi-square analysis indicated a relationship between MoCA score<22 and cerebral perfusion pressure (p= .019). The MoCA may be more sensitive in identifying subtle cognitive changes than MMSE. Early identification of CD may help prevent permanent CD and may improve adherence to self-care regimen. A longitudinal study is warranted to validate the MoCA.