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The Montreal Cognitive Assessment as a Cognitive Screening Tool in Athletes

  • Chantel Teresa Debert (a1) (a2), Joan Stilling (a1), Meng Wang (a1), Tolulope Sajobi (a1) (a3), Kristina Kowalski (a2), Brian Walter Benson (a1) (a2) (a4) (a5) (a6), Keith Yeates (a2) and Sean Peter Dukelow (a1) (a5) (a7)...

Abstract:

Background: The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool known to accurately measure mild cognitive impairment (MCI) in many different neurological populations. Objective: We aimed to determine whether a sport-related concussion (SRC) history and other concussion modifiers influence global cognitive function in high-performance athletes. Methods: A cross-sectional study of 326 varsity and national team athletes aged 18–36 years was completed at the University of Calgary Sports Medicine Clinic, Calgary, Alberta, Canada. Logistic regression analysis was used to examine the association between the total MoCA score, MoCA subscales, and number of previous SRC, adjusting for age, sex, sport participation (SP), and concussion modifiers. Results: Athletes with a history of three or more SRC were 5.36 times more likely to score less than 26/30 on the MoCA (the cutoff for MCI) compared to athletes with two or less SRC (p = 0.02). Males were 2.23 times more likely to have MCI than females (p = 0.0004). There was a significant relationship between the number of previous concussions and the MoCA subscales of attention (p = 0.05) and abstraction (p = 0.003). Age, SP, and concussion modifiers (migraine, depression, anxiety, and attention deficit and hyperactivity disorder) did not influence the relationship between MoCA and previous concussion history. Conclusion: In the appropriate clinical context, cognitive screening with the MoCA may benefit clinical care in athletes with multiple previous SRC, but should not replace a full neuropsychological assessment. Thus, further research is needed to compare the MoCA to full neuropsychological assessments in this population.

L’évaluation cognitive de Montréal comme outil de dépistage pour les athlètes. Contexte: L’évaluation cognitive de Montréal (MoCA en anglais) constitue un outil de dépistage cognitif réputé pour mesurer de façon précise des troubles légers de la cognition (TLC) parmi divers segments de la population. Objectif: Nous avons cherché à déterminer dans quelle mesure des commotions cérébrales antérieures liées au sport ainsi que des facteurs modificateurs produits par ces mêmes commotions peuvent avoir un impact sur les fonctions cognitives globales d’athlètes de haut niveau. Méthodes: Une étude de prévalence incluant 326 athlètes universitaires et membres d’équipes nationales âgés entre 18 et 36 ans a été complétée à la Clinique de médecine sportive de l’Université de Calgary (Canada). Pour ce faire, nous avons fait appel à l’analyse de régression logistique pour examiner l’association pouvant exister entre les scores totaux au MoCA, les sous-échelles du MoCA et le nombre de commotions cérébrales liées à la pratique d’un sport, et ce, après contrôle de l’âge, du sexe, du taux de participation sportive et des facteurs modificateurs liés à ces mêmes commotions. Résultats: Les athlètes victimes de trois commotions cérébrales ou plus en lien avec la pratique d’un sport étaient 5,36 fois plus susceptibles d’obtenir un score de moins de 26/30 au MoCA (la valeur seuil d’un TLC) en comparaison avec des athlètes ayant subi deux commotions ou moins (p = 0,02). Les hommes étaient par ailleurs 2,23 fois plus susceptibles que les femmes de souffrir de TLC (p = 0,0004). De plus, on a noté une relation notable entre le nombre de commotions cérébrales antérieures et les sous-échelles de l’attention (p = 0,05) et de l’abstraction (p = 0,003) du MoCA. L’âge, le taux de participation sportive et les facteurs modificateurs induits par les commotions cérébrales (migraine, dépression, anxiété, TDAH) n’ont pas eu d’incidence sur la relation entre les scores au MoCA et des antécédents de commotions cérébrales. Conclusion: Dans un contexte clinique approprié, le dépistage cognitif au moyen du MoCA pourrait améliorer les soins cliniques prodigués aux athlètes victimes de nombreuses commotions cérébrales. Il ne devrait toutefois pas remplacer une évaluation neuropsychologique complète si cela est nécessaire. De ce point de vue, des recherches plus approfondies sont nécessaires afin de comparer le MoCA à une évaluation neuropsychologique complète dans le cas de ce segment de la population.

Copyright

Corresponding author

Correspondence to: Chantel Teresa Debert, Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, 1403-29 St. NW, Calgary, AB T2N2T9, Canada. Email: chantel.debert@ahs.ca

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