The Montreal cognitive assessment as a cognitive screening tool in sickle cell disease: Associations with clinically significant cognitive domains

• Authors: Macy L Early, Johns Hopkins School of Medicine; Elizabeth Linton, Johns Hopkins School of Public Health; Allison Bosch, Emory University; Timothy Campbell, University of Rochester; Felicia Hill-Briggs, Feinstein Institutes for Medical Research; Lydia H Pecker, Johns Hopkins School of Medicine; Eboni I Lance, Kennedy Krieger Institute; Sophie Lanzkron, Johns Hopkins School of Medicine
• Journal Title: BRITISH JOURNAL OF HAEMATOLOGY
• Volume: Volume 198, Number 2
• Publisher: Wiley | 2022-07-01, Pages 382-390
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1111/bjh.18188
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: cognitive performance; cognitive screening; health literacy; Montreal Cognitive Assessment; sickle cell disease

Abstract

Adults with sickle cell disease (SCD) are at risk for cognitive impairment, which causes significant morbidity. Guidelines support routine cognitive screening, but no screening test is validated in this population. We explored the Montreal Cognitive Assessment (MoCA) as a possible screening test in SCD. We administered the MoCA; a literacy test, the Wide Range Achievement Test, fourth edition (WRAT‐4); and a health literacy test, the Shortened Test of Functional Health Literacy in Adults (S‐TOFHLA) to adults with SCD and gathered clinical variables through chart review. Spearman's rho, Mann–Whitney, and Kruskal–Wallis tests and quantile regression models were used. Among our sample of 49 adults with SCD, the median MoCA score was 25.0 [interquartile range (IQR) 22.0–28.0]. Higher educational attainment was associated with MoCA scores (p = 0.001). In multivariable models, MoCA scores were associated with S‐TOFHLA (p = 0.001) and WRAT‐4 Reading (p = 0.002) scores, and overt stroke (p = 0.03) at the median. This pilot study adds to the limited literature of cognitive screening tests in adults with SCD and demonstrates a relationship between MoCA scores and measures of literacy and health literacy. The MoCA is a promising option for briefly screening for cognitive impairment in adults with SCD, though further study is needed to confirm its validity.