2025 American Academy of Neurology Abstract Website

Objective:

To compare Montreal Cognitive Assessment (MoCA) screening scores in U.S. Veterans with epilepsy with or without subjective cognitive complaints (CC) and healthy controls.

Background:

Cognitive impairment is commonly reported in people with epilepsy (PWE). Studies demonstrate MoCA scores are lower in PWE with CC, but no published studies have compared cognitive screening results between PWE with or without subjective CC. While starting a clinical trial of methylphenidate for Veterans with CC, our team encountered control subject enrollment challenges due to PWE without CC scoring below normal range on the MoCA.

Design/Methods:

We conducted a descriptive subanalysis of all consented subjects who have undergone MoCA testing as part of a multisite study “Methylphenidate for the Treatment of Epilepsy-related Cognitive Deficits” (NCT04419272). MoCA scores 26-30 are considered normal, 18-25 suggest Mild Cognitive Impairment (MCI), and below 18 suggest moderate to severe impairment.

Results:

The 12 subjects enrolled to date include 5 with epilepsy without CC, 5 with epilepsy with CC, and 2 healthy controls. None reported seizures immediately prior to testing. The sample was 83.3% male with a median age of 38 years (IQR 30.5-58.5) and a median of 14.5 years of education (IQR 12.75-15). The median overall MoCA score was 23.5 (IQR 20.5-26), including 22 (IQR 19-26) for epilepsy without CC, 23 (IQR 21-24.5) for epilepsy with CC, and 28.5 for healthy controls. All PWE with CC (n=5/5) and 80% of PWE without CC (n=4/5) screened positive for MCI. Overall, 90% (n=9/10) of epilepsy subjects scored below 26 on the MoCA.

Conclusions:

In our study to date, Veterans with epilepsy with and without CC have similarly low MoCA scores, suggesting that some may not recognize their cognitive impairment. This finding suggests more PWE may merit objective cognitive screening, regardless of cognitive self-assessment.