Aim

The survival rate of out-of-hospital cardiac arrest (OHCA) patients has increased over the past decades. This gives rise to a growing number of patients with hypoxic-ischemic brain damage and cognitive impairment. Currently, cognitive impairment is underdiagnosed in OHCA patients. There is a need for a validated cognitive screening instrument to identify patients with cognitive impairment. This study aimed to examine the diagnostic value of the Montreal Cognitive Assessment (MoCA) in patients after OHCA.

Methods

Survivors (age ≥18 years) of OHCA completed the MoCA and a gold standard neuropsychological test battery, including tests for memory, attention, perception, language, reasoning, and executive functioning, at around one year after OHCA. Results of the MoCA are related to the results of the neuropsychological test battery. Analyses of diagnostic accuracy included receiver operating characteristics and calculation of predictive values.

Results

We included 54 OHCA survivors (mean age = 57.3, 74% male). The area under the curve (AUC) was 0.8, 95% CI [0.67, 0.93]. The MoCA showed excellent sensitivity of 86%, 95% CI [57, 98] and adequate specificity of 70.0%, 95% CI [53, 83] to detect cognitive impairment at the regular cut-off score of 26. The positive predictive value of the MoCA was 50%, 95% CI [30, 70] and the negative predictive value was 93%, 95% CI [76, 99].

Conclusion

This study shows that the MoCA may be a valid cognitive screening instrument for use in the OHCA patient population.

中文翻译：

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蒙特利尔认知评估是心脏骤停幸存者的有效认知筛查工具

目的

在过去的几十年中，院外心脏骤停 (OHCA) 患者的存活率有所提高。这导致越来越多的缺氧缺血性脑损伤和认知障碍患者出现。目前，OHCA 患者的认知障碍诊断不足。需要一种经过验证的认知筛查工具来识别患有认知障碍的患者。本研究旨在探讨蒙特利尔认知评估（MoCA）对 OHCA 术后患者的诊断价值。

方法

OHCA 的幸存者（年龄≥18 岁）在 OHCA 后大约一年完成了 MoCA 和金标准神经心理学测试，包括记忆、注意力、感知、语言、推理和执行功能的测试。MoCA 的结果与神经心理学测试组的结果有关。诊断准确性的分析包括接收器操作特性和预测值的计算。

结果

我们纳入了 54 名 OHCA 幸存者（平均年龄 = 57.3，74% 为男性）。曲线下面积 (AUC) 为 0.8, 95% CI [0.67, 0.93]。MoCA 显示出 86%、95% CI [57, 98] 的出色灵敏度和 70.0%、95% CI [53, 83] 的足够特异性，以检测常规截止分数 26 的认知障碍。阳性预测值MoCA 的预测值为 50%、95% CI [30, 70]，阴性预测值为 93%、95% CI [76, 99]。

结论

这项研究表明，MoCA 可能是用于 OHCA 患者群体的有效认知筛查工具。