APPLIED NEUROPSYCHOLOGY: ADULT, 21: 128–135, 2014

Copyright # Taylor & Francis Group, LLC

ISSN: 2327-9095 print=2327-9109 online
DOI: 10.1080/09084282.2013.778260

The Montreal Cognitive Assessment in Persons

with Traumatic Brain Injury
Elaine de Guise
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Traumatic Brain Injury Program and Neurosurgery Department, McGill University Health
Centre-Montreal General Hospital, Montreal, Quebec, Canada

Abdulrahman Yaqub Alturki

Neurosurgery Department, McGill University Health Centre-Montreal General Hospital,
Montreal, Quebec, Canada and Neurology and Neurosurgery, The National Neuroscience
Institute, Riyadh, Saudi Arabia

Joanne LeBlanc, Marie-Claude Champoux, and Céline Couturier

Traumatic Brain Injury Program, McGill University Health Centre-Montreal
General Hospital, Montreal, Quebec, Canada

Julie Lamoureux
Social and Preventive Medicine Department, University of Montreal, Montreal,
Quebec, Canada

Monique Desjardins
Psychiatry Department, McGill University Health Centre-Montreal General Hospital,
Montreal, Quebec, Canada

Judith Marcoux and Mohammed Maleki

Neurosurgery Department, McGill University Health Centre-Montreal General Hospital,
Montreal, Quebec, Canada

Mitra Feyz
Traumatic Brain Injury Program, McGill University Health Centre-Montreal
General Hospital, Montreal, Quebec, Canada

The objective of this study was to examine the performance of patients with traumatic brain
injury (TBI) on the Montreal Cognitive Assessment (MoCA). The MoCA was administered
to 214 patients with TBI during their acute care hospitalization in a Level 1 trauma center.
The results showed that patients with severe TBI had lower scores on the MoCA compared
with patients with mild and moderate TBI, F(2, 211) ¼ 10.35, p ¼ .0001. This difference was
found for visuospatial=executive, attention, and orientation subtests (p < .05). Linear
regression demonstrated that age, education, TBI severity, and the presence of neurological
antecedents were the best predictors of cognitive impairments explaining 42% of the total
variability of the MoCA. This information can enable clinicians to predict early cognitive
impairments and plan cognitive rehabilitation earlier in the recovery process.

Address correspondence to Elaine de Guise, Ph.D., Traumatic Brain Injury Program, McGill University Health Centre, Montreal General
Hospital Site, Room D13-124, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada. E-mail: elainedeguise@hotmail.ca

Key words: Level 1 trauma center, Montreal Cognitive Assessment, outcome, traumatic brain injury
INTRODUCTION
Cognitive deficits are common after a traumatic brain
injury (TBI). Attention, memory, speed of processing,
verbal retrieval, and executive skills are functions that
are frequently impaired (Lezak, Howieson, Bigler, &
Tranel, 2012; Millis et al., 2001; Novack, Alderson,
Bush, Meythaler, & Canupp, 2000). Emotional distress
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and fatigue are also very common after TBI (Lezak
et al., 2012). These deficits tend to persist from several
months to several years after the trauma (Dikmen,
Machamer, Powell, & Temkin, 2003) and lead to a less
than good recovery (Mazeaux et al., 1997).
Some studies have explored how factors such as
demographic or premorbid characteristics, severity of
injury, type and location of lesions, early cognitive
functioning, or posttraumatic amnesia (PTA) influence
cognitive outcome or functional outcome and employ-
ment status at 6 months and 1 year (Cattelani, Tanzi,
Lombardi, & Mazzucchi, 2002; Dawson, Levine,
Schwartz, & Stuss, 2004; Lehtonen et al., 2005; Pastor-
eck, Hannay, & Contant, 2004; Sandhaug, Andelic,
Vatne, Seiler, & Mygland, 2010; Sherer et al., 2002).
More specifically, work done by Warner and colleagues
in 2010 showed that regional brain volumes were asso-
ciated with neuropsychological deficits at 8 months
and acute traumatic diffuse axonal injury was a signifi-
cant biomarker for cognitive outcome after TBI. A more
recent large prospective study by Leitgeb and colleagues
in 2012 involving 863 patients with acute subdural
hematomas revealed that age, severity of TBI, and
neurological status were the main factors influencing
6-month outcomes after severe TBI.
Most of the predictive studies found in the literature
have considered long-term cognitive outcomes of
patients with TBI. Only a few of them have looked at
the very short-term outcome (i.e., outcome at only a
few weeks posttrauma while patients are still in an acute
care or an early rehabilitation setting). One study look-
ing at the prediction of short-term neuropsychological
outcome was carried out by Dikmen, McLean, Temkin,
and Wyler (1986), who found that brain injury was asso-
ciated with early neuropsychological deficits and the
severity indexes of time to following commands and
depth of coma related more closely to 1-month neurop-
sychological outcome than did PTA. Another study
from an acute care setting, which evaluated the relation-
ship between the location of the lesion and cognitive
deficits, was conducted by Levin (1992). Neurobeha-
vioral data obtained during patients’ hospitalization
disclosed no distinctive pattern in subgroups of patients
MoCA IN PERSONS WITH TBI 129
who presented lesions confined to the frontal, temporal,
or frontotemporal regions (Levin, 1992). Another study
using a correlational design showed that the presence of
diffuse axonal injuries was related to behavioral and
cognitive symptoms of frontal dysfunction 8 to 21 days
after trauma, especially in interference tasks (go–no go
and Stroop reaction times) and semantic fluency
(Wallesch, Curio, Galazky, Jost, & Synowitz, 2001).
Moreover, Fork and colleagues (2005) found that
patients with diffuse axonal injuries were impaired on
memory and executive function tests in the first 4 weeks
after TBI and 5 to 8 months post-TBI. Diffusion tensor
imaging (DTI), a more contemporary neuroimaging
technique used to quantify injury to the white fiber,
might prove useful for observation of nonhemorrhagic
axonal injuries and in predicting cognitive and
functional outcome in the TBI population (Silver,
McAllister, & Stuart 2011). A study done by Lipton
et al. (2009) revealed that prefrontal axonal injury
observed with DTI led to worse performances on
executive function tests in patients with TBI. Moreover,
Niogi and colleagues (2008) presented correlations
between microstructural white-matter lesions detected
by DTI and persistent cognitive deficit after TBI. Also,
disturbed cerebral perfusion was identified with normal
noncontrast computed tomography (CT) in patients
with TBI, and this finding was correlated with severity
of injury and outcome in the acute phase of recovery
after TBI (Metting et al., 2009).
There remains a need for more information regarding
predictive models of cognitive function for patients with
mild, moderate, and severe TBI in early rehabilitation or
in the acute care setting. This gap in the literature on
acute cognitive functioning following TBI may be poss-
ibly related to the fact that in an acute care setting, a
complete cognitive assessment with patients suffering
from mild, moderate, and especially severe TBI is not
always feasible. This is regrettable, however, because
an early cognitive profile is valuable for several reasons
including establishing a cognitive prognosis for patients
postevaluation in the emergency room or posttreatment
in the intensive care unit, putting into place early
intervention protocols, planning early on the postacute
discharge orientation, and providing information to
the family as well as dealing with other concerned par-
ties in the patient’s life such as employers, landlords,
or private insurers.
The Montreal Cognitive Assessment (MoCA) is a
brief yet comprehensive cognitive instrument used to
assess the level of impairment in neurological popula-
tions (Nasreddine et al., 2005). This tool is widely used
 130 DE GUISE ET AL.
in several neurological clinical settings such as with
patients with substance use disorders, patients with
Parkinson disease, geriatric patients, and patients who
have had a stroke (Copersino et al., 2009; Dalrymple-
Alford et al., 2010; Godefroy et al., 2011; Nazem et al.,
2009). A study done by Nazem and colleagues (2009)
showed that predictors of cognitive impairment on the
MoCA included being male, being older, having a lower
educational level, and greater disease severity. However,
to our knowledge, no data are available for the TBI
population. Therefore, the aim of the present study
was to explore the cognitive pattern obtained with the
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MoCA in mild, moderate, and severe TBI in the acute
care setting as well as to isolate demographic, clinical,
and medical factors that could predict early cognitive
outcome and evaluate the feasibility and utility of this
tool in the TBI population. We hypothesized that
patients with mild TBI would perform better on the
MoCA than would those with moderate TBI and that
the latter would perform better than would those with
severe TBI. We also hypothesized that the severity of
cerebral damage would affect MoCA scores.
METHOD
Participants
Participants were adult patients with TBI of all severities
admitted between January 2011 and October 2011 to the
TBI program of the McGill University Health Centre-
Montreal General Hospital (MUHC-MGH). Approval
for this study was granted by the research ethics board
of the MUHC-MGH. Admission criteria included being
16 years of age or older and medically able to participate
in cognitive testing. Patients who were not English-
speaking or French-speaking as well as patients with a
diagnosis of dementia were also excluded. In addition,
patients requiring intensive care due to medical insta-
bility and those using narcotics were excluded. Of a total
of 357 admitted patients with TBI, 44 died in the inten-
sive care unit and 214 (68%) met the selection criteria.
Methods
The medical charts of all patients were reviewed to
gather data on the following predictive factors: age,
marital status, living arrangements, education, employ-
ment status, premorbid cognitive limitations (memory,
learning, attention problems), premorbid psychiatric
diagnosis, previous TBI, substance abuse or drug abuse
history, and premorbid neurological history (cerebro-
vascular disease). Data were collected through chart
reviews and interviews with relatives. The interviews
were conducted by an experienced social worker. The
severity of TBI and initial CT scan results classified
according to the Marshall classification were collected
by a neurosurgeon blinded to the procedure (Marshall,
Marshall, & Klauber, 1991). The Glasgow Coma Scale
(GCS) score upon admission to the emergency room
was used to determine severity of TBI. A GCS score
of 13 to 15 reflected mild TBI, 9 to 12 reflected moderate
TBI, and a score of 3 to 8 indicated severe TBI. All of
our predictive variables were available by 1 week
post-TBI. This timeframe was important given the
outcome prediction period set at 3 weeks posttrauma.
The Montreal Cognitive Assessment. The MoCA is
a cognitive screening test (Nasreddine et al., 2005). This
test is administered in about 10 min and is scored on a
maximum of 30 points. The MoCA assesses several
categories of function. The visuospatial=executive cate-
gory includes a clock-drawing task (3 points), a three-
dimensional cube copy (1 point), and the Trail-Making
Test-Part B (TMT-B) task (1 point). Memory is assessed
with a short-term memory recall task (5 points) involv-
ing two learning trials of five nouns and delayed recall
after approximately 5 min. Naming consists of a three-
item confrontation task, and the language category
includes repetition of two syntactically complex sen-
tences (2 points) and a phonemic fluency task (1 point).
Attention is assessed with a target detection task using
tapping (1 point), a serial subtraction task (3 points),
and digits forward and backward tasks (1 point each).
A two-item verbal abstraction task (2 points) is also
included, and finally, orientation to time and place is
evaluated (6 points). This description shows that the
MoCA covers various cognitive domains including
executive functions (TMT-B, phonemic fluency, and ver-
bal abstraction), memory (short-term immediate and
delayed recall), language (confrontation naming, rep-
etition, verbal fluency), attention, concentration and
working memory (serial subtraction, target detection,
digits forward and backward), visuospatial skills (clock
drawing, three-dimensional copy), and orientation.
The MoCA examination was performed within the first
3 weeks postinjury and was administered by two experi-
enced occupational therapists.
Statistics
Descriptive statistics are presented as means, standard
deviations, and ranges for numerical variables and as
proportions for categorical variables. Bivariate associa-
tions are presented as Pearson correlation coefficients
for the association between numerical variables, analy-
ses of variance (ANOVAs) for the association between
numerical variables and categorical variables, and
Kruskall-Wallis for the same type of associations when
 MoCA IN PERSONS WITH TBI 131

the numerical variables showed severely non-normal TABLE 2

distributions. Post-hoc comparisons were done with a Distribution of CT Scan of the Head by Marshall Classification
Category (n ¼ 214)
Bonferroni adjustment to control for the multiplicity
of tests. Linear regressions were done to determine the Marshall Classification Frequency Percentage
best predictors of the outcomes of interest. All analyses 1. Diffuse injury I (no visible intracranial 19 8.88
were done at the p < .05 level of significance using pathology)
STATA Version 12.1 (StataCorp, College Station, TX). 2. Diffuse injury II: Cisterns are present with 134 62.62
midline shift of 0 mm to 5 mm and=or
lesion densities present, no high- or
mixed-density lesions >25 ml
RESULTS 3. Diffuse injury III: Cisterns compressed or 35 16.36
absent, with midline shift of 0 mm to 5 mm,
Descriptive Statistics no high- or mixed-density lesions >25 ml
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4. Diffuse injury IV: Midline shift of >5 mm, 16 7.48

The sample consisted of 214 participants aged 16 to 93 no high- or mixed-density lesions >25 ml
years old (Mage ¼ 55.13 years, SD ¼ 22.68). The GCS 5. Evacuated mass lesion (V): Any lesion 8 3.74
score varied between 3 and 15 (M ¼ 13.18, SD ¼ 2.89). surgically evacuated
6. Nonevacuated mass lesion (VI): high- or 2 0.93
The majority of the sample (n ¼ 118, 55.1%) had mild
mixed-density lesions >25 ml, not
TBI, 26.2% (n ¼ 56) had moderate TBI, and 18.7% surgically evacuated
(n ¼ 40) had severe TBI. Table 1 shows patients’ demo-
graphic characteristics for marital status, living arrange-
ments, education, and employment status. With regards
to other characteristics studied, 60 patients (28.0%) had comparison with Bonferroni adjustment after a signifi-
a history of substance abuse, 19 patients (8.9%) had psy- cant one-way ANOVA, F(2, 211) ¼ 10.35, p ¼ .0001,
chiatric antecedents, 15 patients (7.0%) had a previous indicated that the MoCA total scores were significantly
TBI, 17 patients (7.9%) had a history of neurologic ante- lower in the group of patients with severe TBI compared
cedents before the trauma, and 19 patients (8.9%) had with the patients with mild TBI. This difference was also
previous cognitive limitations. The results of CT scans present in some of the domain scores of the MoCA.
of the head were categorized using the Marshall Table 4 gives the descriptive statistics by group for these
classification and are presented in Table 2. domain scores. A significant difference (p < .05) was
shown between patients with severe TBI and patients
with mild-to-moderate TBI for the visuospatial=execu-
Distribution of MoCA Scores by Severity of TBI tive, attention, and orientation cognitive domains.
Table 3 reports the descriptive statistics for the MoCA
total score by severity category. A pairwise post-hoc Association Between MoCA Scores and the
Marshall Classification
TABLE 1
Demographic Characteristics of the Sample (n ¼ 214) Table 5 presents the descriptive statistics for the MoCA
total score according to the Marshall classification cate-
Variable Frequency Percentage
gories. To determine if certain Marshall categories were
Marital Status Single 68 31.78 associated with the MoCA total score, a one-way
Married=Common Law 74 34.58 ANOVA was performed. Because the sixth category of
Divorced 29 13.55 the Marshall classification had only two participants,
Widowed 27 12.62
Unknown 16 7.48
this category was excluded from the ANOVA. There
Living Alone 73 34.11 was no significant difference between subgroups of
Arrangements Supervised Setting 1 0.47 the classification in terms of the MoCA total score,
With Someone 134 62.62 F(4, 207) ¼ 1.35, p ¼ .251).
With Someone= 6 2.80
Dependents
Education 1–6 years 20 9.35
7–13 years 133 62.15 TABLE 3
14 years or more 61 28.50 Descriptive Statistics of the MoCA Total Score by Severity (n ¼ 214)
Employment Manual Work 33 15.42 Severity N Mean Median SD Min Max
Status Technical Service 35 16.36
Management-Professional 20 9.35 Mild 118 19.02 20 6.38 3 30
Student 17 7.48 Moderate 56 18.83 20 6.09 3 29
Unemployed 27 12.62 Severe 40 13.95 15 6.30 3 27
Retired 83 38.79 Total 214 18.03 19 6.56 3 30
 132 DE GUISE ET AL.

TABLE 4 TABLE 6
Means for the MoCA in Each Cognitive Domain by Severity Category Results of the Linear Regression Predicting the MoCA Total
Score at Discharge (n ¼ 210)
Function Mild Moderate Severe X2

p Difference
Robust Std.
Visuospatial= 3.09 3.10 1.87 15.18 .000
Severe MoCA Total Coefficient Err. t p > jtj
executive < Moderate
and mild Age 0.132 0.015 8.75 .000
Naming 2.55 2.48 2.22 2.91 .230 Education (Base 1–6
Attention 3.97 3.92 2.75 13.84 .001
Severe years)
< Moderate (7–13 years) 2.495 1.250 2.00 .047
and mild (14 years or more) 5.192 1.364 3.81 .000
Language 1.74 1.50 1.30 5.69 .058 GCS 0.976 0.167 5.82 .000
Abstraction 1.09 1.16 0.90 2.24 .326 Neurological antecedents 3.609 1.626 2.22 .028
Memory 1.27 1.37 0.95 1.61 .431 Constant 9.674 2.889 3.35 .001
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Orientation 5.29 5.33 3.95 26.27 .001
Severe

< Moderate
and mild Age was a significant predictor of cognition (p < .001)


Significant p < .05. and was inversely associated with the MoCA score



Kruskall-Wallis chi-square. (i.e., the MoCA scores were lower for older patients).
The GCS score was a significant predictor of cognition
(p < 0.001) and was directly associated with the MoCA
score (i.e., the MoCA scores were higher for patients
There was also no significant difference between sub- with a higher GCS score at arrival). Education and the
groups of the Marshall classification for any of the MoCA presence of preexisting neurological deficits were also
domain scores. No significant difference was shown for the associated with the MoCA. Those with a higher level
MoCA visuospatial subscore (v24df ¼ 3:340, p ¼ .503), of education had significantly higher MoCA scores.
naming (v24df ¼ 8:853, p ¼ .065), attention (v24df ¼ 2:872, Post-hoc comparisons indicated those having more than
p ¼ .579), language (v24df ¼ 3:246, p ¼ .517), abstraction 13 years of schooling had significantly higher MoCA
(v24df ¼ 1:174, p ¼ .883, memory (v24df ¼ 0:943, p ¼ .918), scores compared with those with either 7 to 13 years
or orientation (v24df ¼ 1:668, p ¼ .796). of schooling (p ¼ .001) or those with less than 7 years
of schooling (p < .001). The difference in MoCA scores
between those with less than 7 years of schooling and
Prediction of Cognitive Status at Discharge as
those with 7 to 13 years of schooling was not significant
Measured by the MoCA
(p ¼ .140) in the post-hoc comparisons. Those who had
A linear regression considering age, education, GCS preexisting neurological deficits had lower MoCA scores
score at admission, the Marshall classification category, than did those without preexisting neurological deficits
and the premorbid neurological variable was used to (p ¼ .028). Together, those four variables explained
attempt to determine what variables could predict cog- 42% of the total variability of the MoCA.
nition at discharge as measured by the MoCA total
score. Because the approach used a listwise deletion of
cases, 210 participants were included in this analysis DISCUSSION
due to missing data. The results of this regression analy-
sis with a level of significance of p < .05 are presented in The aim of the present study was to explore the cogni-
Table 6. tive pattern obtained with the MoCA in mild, moderate,
and severe TBI in an acute care setting as well as to
isolate demographic, clinical, and medical factors that
TABLE 5 would predict early cognitive outcome assessed with
Descriptive Statistics of the MoCA Total Score by the MoCA. Our hypothesis on the relationship between
Marshall Categories (n ¼ 214)
TBI severity and scores on the MoCA was partly con-
Marshall Classification N Mean Median SD Min Max firmed: Patients with mild and moderate TBI had better
performances on the MoCA than did those with severe
1 19 18.84 20 5.83 9 28
2 134 18.55 19 6.58 3 30 TBI, but no difference was observed between patients
3 35 16.45 16 6.54 3 29 with mild and moderate TBI. Moreover, age, education,
4 16 15.68 15.5 7.27 3 25 TBI severity (as measured by the GCS score), and
5 8 19.12 20.5 5.86 9 27 neurological antecedents were significant predictors of
6 2 17.5 17.5 9.19 11 24
MoCA scores, but severity of brain damage according
Total 214 18.03 19 6.56 3 30
to the Marshall classification was not.

MoCA and Severity of TBI
Difference in TBI severity is usually related to different
intensities of cognitive impairments. Previous studies
have shown that cognitive impairments associated with
mild TBI are less significant in terms of frequency, inten-
sity, and duration than what is usually observed after a
moderate TBI. The latter is associated with less impair-
ment than in the case of severe TBI (West, Curtis,
Greve, & Bianchini, 2011). In the present study, we
did not obtain the same pattern of level of impairment.
The MoCA total scores were significantly lower in the
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group of patients with severe TBI compared with
patients with mild and moderate TBI, but no difference
was noted between patients with mild and moderate
TBI. The lack of difference between the mild and mod-
erate group could be explained by looking more closely
at the sample of patients with mild TBI. All patients
included in this study were recruited after admission to
a Level 1 tertiary trauma center. Because they required
an admission, it is probable that the admitted patients
with mild TBI were more severely injured than were
any of those who did not require an admission after hav-
ing suffered, for example, a mild concussion. It is poss-
ible that the severity of symptoms for these patients with
mild TBI may have been closer to that of the moderate
TBI group. A group of nonadmitted patients with mild
TBI seen only at the emergency room would probably
show a different pattern of impairments associated with
milder deficits.
Besides the characteristics of this cohort, we could
argue that the lack of a clear discrimination among the
mild and moderate groups could be explained by a lack
of sensitivity of the MoCA as a screening tool for the
TBI population or by a lack of discrimination in the
severity classification using the GCS. The MoCA was
originally developed to measure subtle and discrete cog-
nitive deficits in patients with mild cognitive impairments
(Nasreddine et al., 2005), and it is perhaps not well suited
for the TBI population with more severe cognitive
impairments. In fact, the scores of our cohort fell far
below the cutoff score of 26. It is a screening tool for glo-
bal cognition and may not work as well for estimating
levels of impairments (Rossetti, Lacritz, & Cullum, 2011).
Further to the issue of tool sensitivity, it also seems
that the MoCA may not be ideal to differentiate the
level of cognitive impairments in relation to the extent
of brain damage sustained. The MoCA scores did dis-
criminate the results of the CT scan (diffuse injury)
and the presence or absence of a mass lesion evacuation.
There was no significant difference between subgroups
of the Marshall classification for the MoCA total or
subscale scores. Other studies have also observed an
absence of correlation between brain lesions and
cognition (Levin, 1992; Paul et al., 2011). For example,
MoCA IN PERSONS WITH TBI 133
a study done by Paul and colleagues (2011) showed only
a modest correlation between individual subscales of the
MoCA and neuroimaging variables (magnetic resonance
imaging) without a pattern of shared variance between
the MoCA total score and neuroimaging indexes.
A comprehensive and qualitative analysis of cognitive
domains would certainly be a better way to use the
MoCA in the TBI population because the global score
appeared to be less sensitive. This lack of discrimination
with the total score could be related to the fact that some
of the cognitive domains assessed by the MoCA are not
usually as impaired as others following TBI. In fact,
studies have revealed that naming, language, and
abstraction are more resistant to TBI than are executive
functioning, attention, and orientation processes
(Dikmen et al., 2009; Dikmen, Machamer, Winn, &
Temkin, 1995; Mathias & Wheaton, 2007; Vakil, 2005;
Willmott, Ponsford, Hocking, & Schonberger, 2009).
In the current investigation, a similar impairment
pattern was found with the MoCA. More specifically,
a significant difference (p < .05) was shown between
patients with severe TBI and those with mild and
moderate TBI for the visuospatial=executive, attention,
and orientation cognitive domains, whereas no differ-
ence was observed in the other cognitive domains of
naming, language, abstraction, and memory.
Prediction of the MoCA Scores
Despite the lack of a clear discrimination by MoCA
global and subscales scores of TBI severity in terms of
mild, moderate, and severe, results obtained when ana-
lyzing GCS scores as linear data in the linear regressions
show that in fact TBI severity did influence performance
on the MoCA as MoCA scores were higher for patients
with a higher GCS score at arrival. Moreover, age and
education were also considered significant variables
related to the MoCA performances. The MoCA scores
were lower for older patients, and those having a higher
education level had significantly increased MoCA
scores. More specific to education, analyses indicated
that those with more than 13 years of schooling had sig-
nificantly higher MoCA scores compared with those
with either 7 to 13 years of schooling or less than 7 years
of schooling. These results with a TBI population are in
keeping with several previous studies that have shown
that age and education have an effect on MoCA perfor-
mance. Standardized norms were adjusted for these two
variables (Freitas, Simoes, Alves, & Santana, 2012;
Nasreddine et al., 2005; Rossetti et al., 2011). Finally,
the presence of a preexisting neurological problem
(cerebrovascular) also influenced MoCA scores, which
has also been reported in the literature on patients
who have had a stroke (Heruti et al., 2002; Rabadi,
 134 DE GUISE ET AL.
Rabadi, Edelstein, & Peterson, 2008; Toglia, Fitzgerald,
O’Dell, Mastrogiovanni, & Lin, 2011; Zwecker et al.,
2002). Taken together, the prediction variables identified
in the present study with a TBI population are quite
similar to those found by Nazem and colleagues (2009)
with patients have had a stroke (age, education, greater
disease severity).
In conclusion, based on the results of this research, the
MoCA global score seems to lack sensitivity for
estimating levels of impairment in the TBI population,
especially when it comes to differentiating between moder-
ate TBI and mild TBI needing hospitalization and the
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MoCA global score should probably not be used to inter-
pret in a cursory fashion cognitive impairment post-TBI.
Qualitative analysis of the MoCA results could, however,
provide some useful information in some cognitive
domains. Importantly, it would seem that a more compre-
hensive cognitive assessment remains to be the method of
choice to discriminate between levels of cognitive impair-
ment following mild, moderate, and severe TBI. More-
over, as already shown in several other populations, age
and education are significant variables influencing MoCA
scores in the TBI population.
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