Acute cardiac care & resuscitation
Combined use of the Montreal Cognitive Assessment and Symbol Digit Modalities Test improves neurocognitive screening accuracy after cardiac arrest: A validation sub-study of the TTM2 trial
Authors' conclusion
The MoCA and SDMT have acceptable diagnostic accuracy for screening for neurocognitive impairment in an OHCA population, and when used in combination the sensitivity improves. Patient and observer-reports correspond poorly with neurocognitive performance.
Study context
- Population
- Out-of-hospital cardiac arrest (OHCA) survivors in the TTM2 trial, assessed at 6 months
- Participants
- 108 OHCA survivors
- Comparison
- Neurocognitive screening tools (Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT), Two Simple Questions (TSQ), Informant Questionnaire on Cognitive Decline in the Elderly-Cardiac Arrest (IQCODE-CA)) vs comprehensive neuropsychological test battery (gold standard)
- Outcome
- Sensitivity and specificity for neurocognitive impairment vs comprehensive neuropsychological test battery
- Follow-up
- 6 months
Methodological detailsvalidation sub-study of the TTM2 trial
- Validation sub-study of the TTM2 trial
Performance
As reported in the abstract
Neurocognitive impairment
| Test or model | AUC | Sensitivity | Specificity |
|---|---|---|---|
| MoCA | Not reported in the abstract | 0.64 | 0.85 |
| SDMT | Not reported in the abstract | 0.59 | 0.83 |
| TSQ | Not reported in the abstract | 0.28 | 0.74 |
| IQCODE-CA | Not reported in the abstract | 0.42 | 0.60 |
| MoCA or SDMT combined | 0.77 (95% CI 0.69, 0.85) | 0.81 | 0.74 |
AUC
MoCANot reported in the abstract
SDMTNot reported in the abstract
TSQNot reported in the abstract
IQCODE-CANot reported in the abstract
MoCA or SDMT combined0.77 (95% CI 0.69, 0.85)
Sensitivity
MoCA0.64
SDMT0.59
TSQ0.28
IQCODE-CA0.42
MoCA or SDMT combined0.81
Specificity
MoCA0.85
SDMT0.83
TSQ0.74
IQCODE-CA0.60
MoCA or SDMT combined0.74
Further findings
Unidentified impairments by domain
- Most common unidentified impairments in episodic memory and executive functions; fewer false negatives with MoCA or SDMT combined
Original publication
Combined use of the Montreal Cognitive Assessment and Symbol Digit Modalities Test improves neurocognitive screening accuracy after cardiac arrest: A validation sub-study of the TTM2 trial. Resuscitation. Published 13 August 2024. doi:10.
Summarised from the published abstract; every number is checked against it