However, a reliable change cannot be detected for patients with a baseline MoCA of 26 or greater, necessitating a different cognitive assessment tool for these patients. Time since onset of memory problems and post-TT/ELD gait function were the only clinical factors significantly associated with having a reliable change in MoCA after shunt insertion ( p = 0.019 p = 0.03, respectively).Ĭonclusions: In patients with iNPH, clinicians could consider using a threshold of 5 points for determining whether iNPH-symptomatic patients have experienced cognitive benefits from cerebrospinal fluid drainage at an individual level. Among shunted patients, 23.4% improved by at least 5 points on the MoCA from baseline to post-shunt. Compared to patients who did not receive a shunt, patients who received a shunt did not have lower average MoCA at baseline ( p = 0.88) or have better improvement in MoCA scores after the tap test ( p = 0.17). 10.1% had at least a 5-point increase from baseline to post-TT/ELD. Reliable change thresholds varied across methods from 4 to 7 points for patients outside of this range. Furthermore, a majority of reliable change methods indicated that a 5-point increase in MoCA would be reliable for patients with a baseline MoCA from 14 to 25. Results: All nine of reliable change methods indicated that a 5-point increase in MoCA would be reliable for patients with a baseline MoCA from 16 to 22 (38.4% of patients). Baseline characteristics of patients whose post-shunt MoCA did and did not exceed the reliable change threshold were compared. Reliable change thresholds for MoCA were derived using baseline visit to pre-TT/ELD assessment using nine different methodologies. Patients who were determined to be good candidates for shunts ( N = 71, 31.7%) took another MoCA assessment following shunt insertion.

Methods: Patients ( N = 224) presenting with symptoms of iNPH were given a MoCA assessment at their first clinic visit, and also before and after tap test (TT) or extended lumbar drainage (ELD). Furthermore, we aimed to determine the likelihood that shunted patients will demonstrate significant improvement on the MoCA, and to identify possible predictors of this improvement. Objectives: We sought to estimate reliable change thresholds for the Montreal Cognitive Assessment (MoCA) for older adults with suspected Idiopathic Normal Pressure Hydrocephalus (iNPH).

3Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.

2Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.

1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.Eric Wesner 1 * Lacey Etzkorn 2 * Shivani Bakre 2 Jinyu Chen 2 Alexander Davis 1 Yifan Zhang 2 Sevil Yasar 1 Aruna Rao 1 Mark Luciano 3 Jiangxia Wang 2 Abhay Moghekar 1

Normal moca test score vs age