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Interchangeability of two versions of the Montreal Cognitive Assessment for the longitudinal evaluation of patients with breast cancer

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Abstract

Purpose

The cognitive performance of patients with breast cancer (BCa) may be affected by cancer and its treatments. The Montreal Cognitive Assessment (MoCA) is a widely used cognitive impairment screening tool, but practice effects must be considered for longitudinal assessments. Since learning effects could be overcome through the alternate use of two versions of the MoCA, we aimed to explore their interchangeability by comparing their overall, and domain- and task-specific, scores among patients with BCa.

Methods

BCa patients from the NEON-BC cohort were evaluated with the MoCA, version 7.1, after diagnosis and after 1 year. At the 3-year follow-up (n = 422), the 7.1 and 7.3 versions were applied at the beginning and at the end (approximately 1 h later) of this evaluation, respectively. Agreements between versions, regarding total, sub-domain, and task scores, were assessed using Bland–Altman plots and intraclass correlation coefficients (ICC).

Results

The mean total scores were not statistically different between versions and the ICC was 0.890. The Bland–Altman limits of agreement were − 3.70 to 3.88. For women with midrange scores, total scores were significantly higher in version 7.1. There were significant differences in the percentage of correct answers in 7 out of 12 tasks, being the highest for the copy of a geometric figure (more than twofold higher with version 7.3). In version 7.1, the language and memory domains presented higher scores and lower visuospatial ability.

Conclusion

Despite similar overall scores being obtained with the two versions of the MoCA, there were item-specific differences that may compromise their interchangeable use.

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Data availability

The datasets generated and analyzed in this study will not be publicly available given that the included patients do not specifically provide their consent for public sharing of their data and that anonymization is unlikely to be feasible, since the identification of patients treated in only one institution within a relatively short period may be possible when taking sociodemographic and clinical characteristics into account.

Code availability

Not applicable.

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Funding

Data management activities at baseline and 1-year follow-up were supported by the Chair on Pain Medicine of the Faculty of Medicine, University of Porto, and by the Grünenthal Foundation-Portugal. Three- and 5-year evaluations were conducted within the research activities of the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit, UIDB/04750/2020) funded by national funding from Fundação para a Ciência e a Tecnologia—FCT (Ministério da Educação e Ciência), and of the project “A five-year prospective cohort study on the neurological complications of breast cancer: frequency and impact in patient-reported outcomes” (POCI-01–0145-FEDER-016867, Ref. PTDC/DTP-EPI/7183/2014) funded by European Regional Development Fund through the Operational Programme Competitiveness and Internationalization and by FCT. LLC and SM were also funded under the scope of the project “NEON-PC—Neuro-oncological complications of prostate cancer: longitudinal study of cognitive decline” (POCI-01–0145-FEDER-032358; ref. PTDC/SAU-EPI/32358/2017). Individual grants attributed to NA (SFRH/BD/119390/2016) and FF (SFRH/BD/92630/2013) were funded by FCT and the “Programa Operacional Capital Humano” (POCH/FSE).

Author information

Authors and Affiliations

  1. EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal

    Natália Araújo, Luisa Lopes-Conceição, Samantha Morais, Filipa Fontes, Vítor Tedim Cruz, Luís Ruano, Susana Pereira & Nuno Lunet

  2. Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal

    Natália Araújo, Samantha Morais, Filipa Fontes, Vítor Tedim Cruz, Luís Ruano, Susana Pereira & Nuno Lunet

  3. Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

    Samantha Morais & Nuno Lunet

  4. Instituto Português de Oncologia do Porto, Porto, Portugal

    Filipa Fontes, Teresa Dias & Susana Pereira

  5. Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Senhora da Hora, Portugal

    Vítor Tedim Cruz

  6. Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal

    Luís Ruano

Authors
  1. Natália Araújo
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  2. Luisa Lopes-Conceição
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  3. Samantha Morais
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  4. Filipa Fontes
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  5. Teresa Dias
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  6. Vítor Tedim Cruz
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  7. Luís Ruano
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  8. Susana Pereira
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  9. Nuno Lunet
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Contributions

Natália Araújo: formal analysis, writing original draft, writing—review and editing; Luísa Lopes-Conceição: investigation, writing—review and editing; Samantha Morais: writing—review and editing; Filipa Fontes: funding acquisition, investigation, data curation, writing—review and editing; Teresa Dias: resources, writing—review and editing; Vítor Tedim Cruz: conceptualization, funding acquisition, writing—review and editing; Luís Ruano: conceptualization, funding, writing—review and editing; Susana Pereira: conceptualization, funding acquisition, investigation, supervision, project administration, writing—review and editing; Nuno Lunet: conceptualization, funding acquisition, supervision, project administration, writing—review and editing.

Corresponding author

Correspondence to Nuno Lunet.

Ethics declarations

Ethics approval

The NEON-BC study was approved by the Portuguese National Authority for Data Protection (no. 9469/2012 and 8601/2014) and by the Ethics Committee of IPO-Porto (Ref. CES 406/011 and CES 99/014). All participants gave their written informed consent.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Araújo, N., Lopes-Conceição, L., Morais, S. et al. Interchangeability of two versions of the Montreal Cognitive Assessment for the longitudinal evaluation of patients with breast cancer. Support Care Cancer 30, 2639–2647 (2022). https://doi.org/10.1007/s00520-021-06702-y

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  • DOI: https://doi.org/10.1007/s00520-021-06702-y

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