Is the difference real, is the difference relevant: the minimal detectable and clinically important changes in the Montreal Cognitive Assessment

Elias Lindvall; Tamar Abzhandadze; Terence J Quinn; Katharina S Sunnerhagen; Erik Lundström

doi:10.1016/j.cccb.2024.100222

Is the difference real, is the difference relevant: the minimal detectable and clinically important changes in the Montreal Cognitive Assessment

Cereb Circ Cogn Behav. 2024 May 3:6:100222. doi: 10.1016/j.cccb.2024.100222. eCollection 2024.

Authors

Elias Lindvall¹, Tamar Abzhandadze^{2

3}, Terence J Quinn⁴, Katharina S Sunnerhagen², Erik Lundström¹

Affiliations

¹ Department of Medical Sciences, Neurology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden.
² Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK.

Abstract

Background and aims: The Montreal Cognitive Assessment (MoCA) is a widely used instrument for assessing cognitive function in stroke survivors. To interpret changes in MoCA scores accurately, it is crucial to consider the minimal detectable change (MDC) and minimal clinically important difference (MCID). The aim was to establish the MDC and MCID of the MoCA within 6 months after stroke.

Methods: This cohort study analysed data from the EFFECTS trial. The MoCA was administered at baseline and at 6-month follow-up. The MDC was calculated as the upper limit of the 95 % confidence interval of the standard error of the MoCA mean. The MCID was determined using anchor-based and distribution methods. The visual analogue recovery scale of the Stroke Impact Scale (SIS [primary anchor]) and Euro Quality of Life-5 Dimensions index (EQ-5D [confirmatory anchor]) were used as anchors. The distribution-based method, the Cohen benchmark effect size was chosen.

Results: In total, 1131 (mean age [SD], 71 [10.6] years) participants were included. The mean (SD) MoCA scores at admission and 6-month follow-up were 22 (5.2) and 25 (4.2), respectively. The MDC of the MoCA was 5.1 points. The anchor method yielded the MCIDs 2 and 1.6 points for SIS and EQ-5D, respectively. Using the distribution method, the MCID for the MoCA was 1 point.

Conclusions: Even a small change in MoCA scores can be important for stroke survivors; however, larger differences are required to ensure that any difference in MoCA values is a true change and is not related to the inherent variation in the test. Due to small sample sizes, the results of the anchor analysis need to be interpreted with caution.

Keywords: Assessment; Clinical trial; Cognition; Diagnosis; Dysfunction; Minimal clinically important difference; Minimal detectable change.