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Utility of Using the Montreal Cognitive Assessment (MoCA) as a Screening Tool for HIV-Associated Neurocognitive Disorders (HAND) In Multi-Ethnic Malaysia

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Abstract

This study determines the optimal cut-off scores for the Montreal Cognitive Assessment (MoCA) to detect HIV-associated neurocognitive disorders (HAND) in a multi-ethnic Malaysian HIV-positive cohort by developing demographically corrected normative standards among 283 HIV-negative community-based controls with overlapping demographic characteristics. The norms (corrected for age, sex, education, ethnicity) were applied to 342 HIV-positive virally suppressed individuals on cART. Impairment rates were classified using the Global Deficit Score (GDS ≥ .5) method. The MoCA was also scored according to the recommended cut-off of ≤ 26, and functional decline was applied to both impairment definitions to classify HAND per the Frascati criteria. The ≤ 26 cut-off considerably overestimated cognitive impairment in both samples (59.4% HIV-negative; 69.3% HIV-positive). In contrast, corrected scores yielded impairment rates consistent with what has been reported internationally in virally suppressed cohorts (23.4% with 83.3% mild impairment, 16.7% moderate impairment). A supplemental file allowing the computation of corrected MoCA scores and impairment status is included.

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Funding

This study was funded by the University of Malaya High Impact Research grants HIR/MOHE H-20001-E000001 (RR, AK, SFO), UM.0000099/HIR.C3 (SK, AVC) and by the National Institute of Allergy & Infectious Diseases of the National Institutes of Health under award number T32AI114398 (TM). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Trena Mukherjee

  2. Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia

    Rishanantini Sakthivel, Ho Yen Fong, Megan McStea, Meng Li Chong, Sharifah Faridah Omar, Adeeba Kamarulzaman & Reena Rajasuriar

  3. Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Sharifah Faridah Omar, Ai Vyrn Chin, Shahrul Kamaruzzaman & Adeeba Kamarulzaman

  4. Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Reena Rajasuriar

  5. The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia

    Reena Rajasuriar

  6. Neuroscience Research Australia, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia

    Lucette A. Cysique

Authors
  1. Trena Mukherjee
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  2. Rishanantini Sakthivel
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  3. Ho Yen Fong
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  11. Lucette A. Cysique
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Corresponding author

Correspondence to Reena Rajasuriar.

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Conflict of interest

All authors declare no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the University of Malaya and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

It was obtained from all individual participants included in the study.

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Mukherjee, T., Sakthivel, R., Fong, H.Y. et al. Utility of Using the Montreal Cognitive Assessment (MoCA) as a Screening Tool for HIV-Associated Neurocognitive Disorders (HAND) In Multi-Ethnic Malaysia. AIDS Behav 22, 3226–3233 (2018). https://doi.org/10.1007/s10461-018-2073-x

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  • DOI: https://doi.org/10.1007/s10461-018-2073-x

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