Assessing the Utility of the Montreal Cognitive Assessment (MoCA) in Screening for Cognitive Impairment in Patients with Systemic Lupus Erythematosus

Objective: Screening for cognitive impairment (CI) in systemic lupus erythematosus (SLE) relies on the American College of Rheumatology (ACR) neuropsychological battery (NB). We studied the concurrent criterion validity to assess the Montreal Cognitive Assessment (MoCA) as a screening tool for CI compared to the ACR-NB and evaluated the added value of the MoCA to the ANAM. Methods: 285 adult SLE patients were administered the ACR-NB, MoCA, and ANAM. For the ACR-NB, patients were classified as CI if there was a z-score of ≤-1.5 in ≥ 2 domains. Area under the curve (AUC) and sensitivities/specificities were determined. A discriminant function analysis was applied to assess the ability of the MoCA to differentiate between CI, undetermined CI, and non-CI patients. Results: CI was not accurately identified by the MoCA compared to the ACR-NB (AUC of 0.66). Sensitivity and specificity were poor 50% and 69%, respectively for the cut-off of 26, and 80% and 45%, respectively for the cut-off of 28. The MoCA had low ability to identify CI status. The addition of the MoCA to the ANAM led to improvement on the AUC by only 2.5%. Conclusion: The MoCA does not have adequate concurrent criterion validity to accurately identify CI in patients with SLE. The low specificity of the MoCA may lead to overdiagnosis and concern among patients. Adding the MoCA to the ANAM does not substantially improve the accuracy of the ANAM. These results do not support using the MoCA as a screening tool for CI in patients with SLE.