Influence of the Intensive Care Unit Environment on the Reliability of the Montreal Cognitive Assessment

Frontiers in Neurology

Julia Velz¹  Luca Regli¹  Martin Nikolaus Stienen¹  Nicolai Maldaner¹  Martina Sebök¹  Emanuela Keller¹  Yannick Rothacher³  Ladina Schlosser³  Olivia Geisseler³  Noemi Dannecker³  Peter Brugger³  Nicolas Roydon Smoll⁴ 

[1] Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland;Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland;Neuropsychology Unit, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland;School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia;

关键词: Montreal Cognitive Assessment;    intensive care unit;    reliability;    neuropsychology;    cognitive evaluation;    neuropsychological assessment;   

DOI  :  10.3389/fneur.2019.00734

来源: DOAJ

【 摘 要 】

Background: Neuropsychological screening becomes increasingly important for the evaluation of subarachnoid hemorrhage (SAH) and stroke patients. It is often performed during the surveillance period on the intensive (ICU), while it remains unknown, whether the distraction in this environment influences the results. We aimed to study the reliability of the Montreal Cognitive Assessment (MoCA) in the ICU environment.Methods: Consecutive stable patients with recent brain injury (tumor, trauma, stroke, etc.) were evaluated twice within 36 h using official parallel versions of the MoCA (ΔMoCA). The sequence of assessment was randomized into (a) busy ICU first or (b) quiet office first with subsequent crossover. For repeated MoCA, we determined sequence, period, location effects, and the intraclass correlation coefficient (ICC).Results:N = 50 patients were studied [n = 30 (60%) male], with a mean age of 57 years. The assessment's sequence [“ICU first” mean ΔMoCA −1.14 (SD 2.34) vs. “Office first” −0.73 (SD 1.52)] did not influence the MoCA (p = 0.47). On the 2nd period, participants scored 0.96 points worse (SD 2.01; p = 0.001), indicating no MoCA learning effect but a possible difference in parallel versions. There was no location effect (p = 0.31) with ΔMoCA between locations (Office minus ICU) of −0.32 (SD 2.21). The ICC for repeated MoCA was 0.87 (95% CI 0.79–0.92).Conclusions: The reliability of the MoCA was excellent, independent from the testing environment being ICU or office. This finding is helpful for patient care and studies investigating the effect of a therapeutic intervention on the neuropsychological outcome after SAH, stroke or traumatic brain injury.

【 授权许可】

Unknown