11/26/2023 0 Comments Moca score interpretation malingering27, 28 Reliable Digit Span is an embedded measure of effort calculated by summing the highest number of digits successfully repeated across 2 consecutive same span-length trials of Digit Span Forward (repeating digits in the same order as administered) and Digit Span Backward (repeating the digits in reverse order). 26 The cutoff score of Digit Span Scaled Score as a PVT for inadequate effort was ≤6, which has been shown to have adequate sensitivity and specificity. The Digit Span Scaled Score was derived from converting the total number of correct trials to age-adjusted norms. The Wechsler Adult Intelligence Scale–Fourth Edition Digit Span subtest 26 assesses auditory attention and working memory through the repetition and sequencing of digits and consists of 3 individual parts (Digit Span Forward, Digit Span Backward, and Digit Span Sequencing). Wechsler Adult Intelligence Scale–Fourth Edition Digit Span subtest Slightly more than half (53%) reported 1 or fewer episodes of disorientation related to head injury, whereas 35% reported 2–4 episodes, and 7% reported 5 or more episodes. Nearly half of the patients (48%) reported no LOC. Patients ranged in age from 21 to 70 years (mean age = 31.33 years, SD = 8.48), with a mean of 13.13 years of education (SD = 1.66 range = 8–18). Most were male (95.7%) and most self-identified ethnically as white (74.4% black: 6.8% Latino: 2.6% Pacific Islander: 0.9% and biracial/multiracial: 1.7% 13.7% declined to respond). One hundred seventeen individuals completed all 4 PVTs and thus comprised the final sample. Of the patients who reported LOC <30 minutes and/or posttraumatic amnesia duration of <24 hours (n = 178), 123 were diagnosed with mTBI by a physical medicine and rehabilitation physician (i.e., physiatrist) during the evaluation, and 39 were clinically determined not to have TBI (6 cases were “diagnostically unclear,” and 10 cases were missing a physician's diagnosis). ![]() The mild TBIs were sustained at least months before our evaluations and on average years before their TBI evaluation. Patients were excluded if they had a TBI of greater than mild severity, as determined by the self-reported duration of loss of consciousness (LOC moderate-severe TBI = LOC > 30 minutes n = 11), or if there was insufficient self-reported data about the injury to determine a diagnosis or severity of TBI (n = 9). One hundred ninety-eight consecutively referred outpatients at a VA tertiary care medical center TBI/Polytrauma Clinic undergoing comprehensive TBI evaluations over a 2-year period (October 2011 to October 2013). ![]() We also anticipated a negative association of self-reported distress (e.g., posttraumatic stress disorder symptoms and pain), poor sleep, and cognitive symptoms with MoCA performance. We hypothesized that indicators of invalid response style (i.e., failure on PVTs and SVTs) would incrementally influence total MoCA scores, in that as the number of such indicators increased, MoCA scores would decrease. This study was designed to evaluate the influence of suboptimal performance validity test (PVT) and symptom validity test (SVT) performances on scores derived from the MoCA. 12 Establishing both validity of cognitive data via tests specifically designed to assess performance validity and validity of symptom self-report via measures designed to assess symptom validity is crucial to drawing conclusions regarding impairment. 8 Given high rates of reporting cognitive symptoms among those with histories of mTBI 9, 10 in the context of evidence that persistent cognitive deficits are unlikely to be directly related to neurologic injury, 11 the importance of assessing validity has been highlighted within this population. 3Ĭonsiderable research in mild traumatic brain injury (mTBI) 7 suggests that cognitive, physical, and emotional symptoms resolve rapidly in most individuals, with full return to baseline within days to weeks. 4, – 6 Nevertheless, evidence suggests that the MoCA should be not be interpreted solely as a measure of cognitive ability, as doing in many instances would lead to excessive false-positive diagnoses because of noncognitive factors. ![]() 1 Research has demonstrated utility of the MoCA across many neurologic populations. The MoCA does not comprehensively measure cognition rather, it provides an estimate of global cognition, assisting clinicians when deciding whether to make referrals for neuropsychological evaluation. ![]() 1 Several studies have demonstrated its psychometric superiority 2, 3 over other screening instruments. The Montreal Cognitive Assessment (MoCA) is a cognitive instrument developed to screen for mild cognitive impairment and dementia.
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