Validity of the Montreal Cognitive Assessment for traumatic brain injury patients with intracranial haemorrhage

Background and primary objective: In recent years, the Montreal Cognitive Assessment (MoCA) has been developed to assess patients with ischemic stroke. However, it has not been validated for use on traumatic brain injury patients with intracranial haemorrhage (tICH). The aim was to evaluate the psychometric properties of the MoCA (MoCA) in such patients. Research design and method: A cross-sectional observational study was carried out on 40 controls and 48 tICH patients recruited in Hong Kong. Concurrent validity was assessed by a comprehensive battery of neuropsychological tests and the Mini-Mental State Examination (MMSE). Criterion validity was assessed by the differentiation of tICH patients from controls. Main outcome and results: In tICH patients, cognitive z-scores (beta = 0.579; p < 0.001) and MMSE (beta = 0.366, p = 0.012) significantly correlated with performance in the MoCA after adjustment for age, gender and total score for the Geriatric Depressive Scale. For the differentiation of tICH patients from controls, analysis of receiver operating characteristics curves in the MoCA revealed an optimal balance of sensitivity and specificity at 25/26 with an area under the curve of 0.704 (p = 0.001). MoCA is applicable to and significantly correlated with excellent neurological outcomes in tICH patients. Conclusions: MoCA is a useful and psychometrically valid tool for the assessment of gross cognitive function in tICH patients.