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Abstract
Background We evaluated Montreal Cognitive Assessment (MoCA) performance in a veteran traumatic brain injury (TBI) population, considering performance validity test (PVT) and symptom validity test (SVT) data, and explored associations of MoCA performance with neuropsychological test performance and self-reported distress.
Methods Of 198 consecutively referred veterans to a Veterans Administration TBI/Polytrauma Clinic, 117 were included in the final sample. The MoCA was administered as part of the evaluation. Commonly used measures of neuropsychological functioning and performance and symptom validity were also administered to aid in diagnosis.
Results Successively worse MoCA performances were associated with a greater number of PVT failures (ps < 0.05). Failure of both the SVT and at least 1 PVT yielded the lowest MoCA scores. Self-reported distress (both posttraumatic stress disorder symptoms and neurobehavioral cognitive symptoms) was also related to MoCA performance.
Conclusions Performance on the MoCA is influenced by task engagement and symptom validity. Causal inferences about neurologic and neurocognitive impairment, particularly in the context of mild TBI, wherein the natural course of recovery is well known, should therefore be made cautiously when such inferences are based heavily on MoCA scores. Neuropsychologists are well versed in the assessment of performance and symptom validity and thus may be well suited to explore the influences of abnormal performances on cognitive screening.
Footnotes
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
Drs. Waldron-Perrine and Gabel completed the data analysis when professionally affiliated with the VA Medical Center Ann Arbor and University of Michigan.
Supported with resources and the use of facilities at the Veterans Affairs Ann Arbor Healthcare System in Ann Arbor, Michigan. The content of this article does not represent the views of the US Department of Veterans Affairs or the US Government.
There was no formal study sponsorship.
Podcast: NPub.org/NCP/podcast9-2a
- Received September 25, 2018.
- Accepted December 3, 2018.
- © 2019 American Academy of Neurology
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