Validity of the Montreal Cognitive Assessment Screener in Adolescents and Young Adults With and Without Congenital Heart Disease.
Nancy A Pike, Marie K Poulsen, Mary A Woo
PMID 28448372WHAT IT FOUND
The MoCA screening test flagged cognitive impairment in adolescents and young adults with congenital heart disease when compared with a longer memory test.
A score below 26 suggested possible impairment in this group.
Key findings
01Adolescents and young adults with congenital heart disease had lower median MoCA scores than healthy controls (23 vs. 28) and lower median GMI scores (85 vs. 108).
02Compared with the WRAML2 GMI, a MoCA cutoff of 26 had sensitivity .94, specificity .80, PPV .70, and NPV .96.
03Fifty-five of 80 participants with congenital heart disease scored below 26 on the MoCA, compared with 10 of 76 healthy controls.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was mostly moderate to severe congenital heart disease, with few simple forms, so the study does not show how well MoCA works across all severities. Participants were aged 14 to 21, so the findings do not cover younger children or older adults. Some healthy controls were friends or relatives of participants, which may make the groups more similar in environmental factors. The study used the WRAML2 general memory index as the reference standard, not a broad neuropsychological diagnosis, and it lacked a suitable WRAML2 comparison for MoCA naming. Attention deficit disorders, anxiety, and depression were not excluded as possible influences on cognitive scores in the congenital heart disease group.
The easy way to misread this
Do not use the MoCA as a diagnosis or as a test for every young person with congenital heart disease. It was validated only against a memory index in adolescents and young adults aged 14 to 21 with surgically palliated disease, mostly moderate to severe, and a low score means referral for fuller testing rather than proof of a cognitive disorder.