PM483 Sensitivity And Specificity Of A Five Minute Cognitive Screen In Heart Failure Patients

Introduction Cognitive dysfunction is exhibited in 24% to 70% of heart failure (HF) patients. A five minute protocol has been recommended by the National Institute of Neurological Disorders and Stroke and the Canadian Stroke Network to screen for vascular cognitive impairment, but this has not been evaluated in HF populations. Objectives To examine whether the three recommended items from the Montreal Cognitive Assessment (MoCA) had adequate sensitivity (>85%) and specificity (≥70%) to be recommend as a five minute screen in detecting possible cognitive dysfunction and need for further evaluation in HF patients. Methods Data analysis of MoCA administered to HF patients enrolled in two disease management programs. Scores <26 on the MoCA characterised cognitive dysfunction. The recommended five minute screen uses three MoCA items (verbal fluency, delayed recall and orientation) with possible scores of 1 to 12 (lower scores indicate poorer cognitive function). Receiver operator characteristics (ROC) were constructed with MoCA <26 as the positive test, to determine the sensitivity and specificity and appropriate cut-score of the five minute cognitive screen. Results The sample (n=221) had a mean age of 76 (SD 12.3) years with 98 (44%) females and 110 (48%) NYHA class III. The mean MoCA was 24.2 (SD 3.5) and 134 (61%) patients were identified as having possible cognitive dysfunction. Actual scores on the five minute screen ranged from 3 to 11 (x̅ 8.56, SD 1.8) and as expected were strongly correlated with overall MoCA score (r=0.72, p<0.001) and MoCA cut-off score <26 (r=0.63, p<0.01). A cut-off score ≤9 on the 5-minute cognitive screen provided 89% sensitivity and 70% specificity, and the area under the ROC curve was good (0.88, p<0.01, 95% CI 0.83 to 0.92). Conclusion Using a cut-off score ≤9, the three recommended items from the MoCA (verbal fluency, delayed recall and orientation) had adequate sensitivity and specificity to be used as a five minute screen to detect possible cognitive dysfunction in HF patients.