MoCA as a Measure of Cognitive Outcomes in Progressive Supranuclear Palsy (PSP)
Vanessa Ibrahim1, Catherine Isroff1, Jay Iyer2, Ece Bayram3, Leila Montaser Kouhsari4, Matthew Swan5, Marian Dale6, Anthony Lang7, Lawrence Golbe8, Douglas Gunzler9, Anne-Marie Wills10
1Department of Neurology, Massachusetts General Hospital, 2Department of Molecular and Cellular Biology and Statistics, Harvard University, 3Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, 4Department of Neurology, Brigham and Women's Hospital, 5Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, 6Department of Neurology, Oregon Health and Science University, 7Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre, Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital, 8Rutgers Robert Wood Johnson Medical School, 9MetroHealth Medical Center, School of Medicine, Case Western Reserve University, 10Department of Neurology, Massachusetts General Hospital, Harvard Medical School
Objective:
To evaluate the longitudinal performance of the Montreal Cognitive Assessment (MoCA) as a measure of cognitive outcomes in progressive supranuclear palsy (PSP).
Background:
The MoCA is a widely recognized and well-validated assessment tool for the detection of mild cognitive impairment (MCI). Its brief and efficient administration presents a potential advantage over established outcome measures for PSP, such as the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). However, its effectiveness as a cognitive outcome measure in PSP has yet to be formally validated.
Design/Methods:
Cognitive assessment data, including the MoCA, RBANS, and PSP Rating Scale (PSPRS), from 162 participants diagnosed with PSP (mean age 69.1, 55% male) in the placebo arm of the Biogen PASSPORT study (NCT03068468) were analyzed using linear mixed-effects modelling (LMM) and repeated measures correlations (rmcorr).
Results:
LMM analysis reported a statistically significant time effect on the MoCA score over a 48-week period (p < 0.0001). At baseline, the estimated marginal mean (EMM) was 21.6 ± 0.5 (SE). By week 48, the EMM for the change in MoCA score was -1.4 ± 0.3 (SE). Small but significant changes were observed in all domains except abstraction. Over the same 48-week period, the MoCA correlated only weakly with the RBANS total scale (rmcorr = 0.1, p = 0.02), but exhibited a stronger correlation with the PSPRS (rmcorr = -0.22, p < 0.0001).
Conclusions:
While the MoCA effectively identifies MCI at baseline and some decline over time, it appears to have limited sensitivity in capturing the specific and substantial cognitive decline associated with PSP. The correlation between the MoCA and the PSPRS could suggest that the MoCA is sensitive to motor and oculomotor dysfunction.