19047
The Montreal Cognitive Assessment Is a Superior Office Cognitive Screening Exam for Adults with Autism Spectrum Disorders
Objectives: To determine the best cognitive screening exam for adults with ASDs by comparing patterns of performance on three commonly administered office mental status examinations
Methods: In this cross sectional study 51 adults with ASDs, mean age 32 +/- 12 years (range 20-58 years), 71% men, with mean educational level of 13.5 +/- 2.3 years (range 10-20 years), and mean WAIS Full Scale IQ 94 +/- 21, underwent three office mental status examinations – the Folstein Mini-Mental State Exam (MMSE), the Kokmen Short Test of Mental Status (STMS), and the Montreal Cognitive Assessment (MoCA). Scores on the exams were correlated with total scores on the Social Responsiveness Scale (SRS) and WAIS Full Scale IQ.
Results: Total scores (mean +/- SD) and percent correct (mean +/- SD of total possible points) for each of the mental status examinations were as follows: MoCA 25.2 +/- 4.3, 84 +/- 14%; STMS 34 +/- 4.4, 89 +/- 12%; MMSE 27.1 +/- 3.7, 90 +/- 12%. Recall was the domain most commonly missed on each of the mental status examinations: MoCA 65 +/- 33(%); STMS 76 +/- 27(%); MMSE 79 +/- 28(%). Total score on the SRS did correlate (r, P) with MoCA Total Score (-.29, .04) and Recall (-.34, .02), as well as STMS Attention (-.29, .04) and Calculation (-.35, .01). WAIS Full Scale IQ correlated (r, P) positively with performance on each of the office screening exams: MoCA (.54, <.001); STMS (.79, <.001); MMSE (.75, <.001).
Conclusions: In this sample of adults with ASDs, performance on the MoCA was worse relative to performance on the STMS or MMSE, and that performance was correlated with degree of social impairment. This suggests that the MoCA may be the superior office screening instrument for detection of cognitive dysfunction in adults with ASDs. Verbal recall was the most prominent cognitive deficit evident onroutine office mental status examination screening, which could imply a risk for misdiagnosis in those without an established ASD diagnosis. Abnormal office screening exams should be followed by confirmatory neuropsychological testing.