Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation
Introduction: Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains. Objective: To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpati...
- Autores:
-
montaño-lozada, juan-manuel
López, Norman
ESPEJO ZAPATA, LINA MARIA
Soto-Añari, Marcio
Ramos-Henderson, Miguel
Caldichoury-Obando, Nicole
Camargo, Loida
- Tipo de recurso:
- http://purl.org/coar/resource_type/c_816b
- Fecha de publicación:
- 2021
- Institución:
- Corporación Universidad de la Costa
- Repositorio:
- REDICUC - Repositorio CUC
- Idioma:
- eng
- OAI Identifier:
- oai:repositorio.cuc.edu.co:11323/8900
- Acceso en línea:
- https://hdl.handle.net/11323/8900
https://doi.org/10.1016/j.yebeh.2021.108158
https://repositorio.cuc.edu.co/
- Palabra clave:
- Epilepsy
Short cognitive tests
(MoCA) Test
Cognitive dysfunction
Mental impairment
- Rights
- openAccess
- License
- CC0 1.0 Universal
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| dc.title.spa.fl_str_mv |
Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation |
| title |
Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation |
| spellingShingle |
Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation Epilepsy Short cognitive tests (MoCA) Test Cognitive dysfunction Mental impairment |
| title_short |
Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation |
| title_full |
Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation |
| title_fullStr |
Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation |
| title_full_unstemmed |
Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation |
| title_sort |
Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation |
| dc.creator.fl_str_mv |
montaño-lozada, juan-manuel López, Norman ESPEJO ZAPATA, LINA MARIA Soto-Añari, Marcio Ramos-Henderson, Miguel Caldichoury-Obando, Nicole Camargo, Loida |
| dc.contributor.author.spa.fl_str_mv |
montaño-lozada, juan-manuel López, Norman ESPEJO ZAPATA, LINA MARIA Soto-Añari, Marcio Ramos-Henderson, Miguel Caldichoury-Obando, Nicole Camargo, Loida |
| dc.subject.spa.fl_str_mv |
Epilepsy Short cognitive tests (MoCA) Test Cognitive dysfunction Mental impairment |
| topic |
Epilepsy Short cognitive tests (MoCA) Test Cognitive dysfunction Mental impairment |
| description |
Introduction: Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains. Objective: To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpatient consultation at a reference diagnostic center in Colombia and analyze and the influencing factors. Materials and methodology: One-hundred and four patients during neurology outpatient consultation in the city of Cartagena, Colombia, were assessed with the (MoCA) test, i.e., 54 people who consulted for headache and have not been diagnosed with epilepsy (NEP) and 50 with a diagnosis of epilepsy (EPs) according to the diagnostic criteria of the International League Against Epilepsy (ILAE). Results: Significant differences were found in the total mean scores of the (MoCA) between (EPs) and (NPE) groups (t = 4.72; p < 0.01), particularly in attention (t = 3.22; p < 0.02) and memory (t = 5.04; p < 0.01) dimensions. Additionally, a significant association was observed between years of schooling and (MoCA) scores (p = 0,019) but not between socioeconomic level (p = 0,510), age (p = 0,452) and the frequency of seizures (p = 0,471). Discussion: Patients with epilepsy show lower scores in several cognitive domains in respect of the control group. The (MoCA) has proven its appropriateness for cognitive screening in the contexts of clinical neurology outpatient consultation. |
| publishDate |
2021 |
| dc.date.accessioned.none.fl_str_mv |
2021-11-23T19:20:08Z |
| dc.date.available.none.fl_str_mv |
2021-11-23T19:20:08Z |
| dc.date.issued.none.fl_str_mv |
2021 |
| dc.date.embargoEnd.none.fl_str_mv |
2022 |
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Pre-Publicación |
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http://purl.org/coar/resource_type/c_816b |
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Text |
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info:eu-repo/semantics/preprint |
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http://purl.org/redcol/resource_type/ARTOTR |
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info:eu-repo/semantics/acceptedVersion |
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http://purl.org/coar/resource_type/c_816b |
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acceptedVersion |
| dc.identifier.issn.spa.fl_str_mv |
1525-5050 1525-5069 |
| dc.identifier.uri.spa.fl_str_mv |
https://hdl.handle.net/11323/8900 |
| dc.identifier.doi.spa.fl_str_mv |
https://doi.org/10.1016/j.yebeh.2021.108158 |
| dc.identifier.instname.spa.fl_str_mv |
Corporación Universidad de la Costa |
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REDICUC - Repositorio CUC |
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https://repositorio.cuc.edu.co/ |
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1525-5050 1525-5069 Corporación Universidad de la Costa REDICUC - Repositorio CUC |
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https://hdl.handle.net/11323/8900 https://doi.org/10.1016/j.yebeh.2021.108158 https://repositorio.cuc.edu.co/ |
| dc.language.iso.none.fl_str_mv |
eng |
| language |
eng |
| dc.relation.references.spa.fl_str_mv |
[1] Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014;55 (4):475–82. [2] Michaelis R, Tang V, Goldstein LH, Reuber M, LaFrance WC, Lundgren T, et al. Psychological treatments for adults and children with epilepsy: Evidencebased recommendations by the International League Against Epilepsy Psychology Task Force. Epilepsia 2018;59(7):1282–302. [3] Aji BM, Larner AJ. Cognitive assessment in an epilepsy clinic using the AD8 questionnaire. Epilepsy Behav 2018;85:234–6. [4] Helmstaedter C, Witt J-A. Epilepsy and cognition–a bidirectional relationship? Seizure 2017;49:83–9. [5] Breuer LEM, Grevers E, Boon P, Bernas A, Bergmans JWM, Besseling RMH, et al. Cognitive deterioration in adult epilepsy: clinical characteristics of ‘‘Accelerated Cognitive Ageing”. Acta Neurol Scand 2017;136(1):47–53. [6] Falco-Walter JJ, Scheffer IE, Fisher RS. The new definition and classification of seizures and epilepsy. Epilepsy Res 2018;139:73–9. [7] Natham R, Amirthalingam P, Arunachalam G. Comparison of Montreal Cognitive Assessment (MOCA) with Mini Mental State Examination (MMSE) on association between homocysteine and cognitive status in epilepsy patients with phenytoin monotherapy. Asia Pac J Couns Psychother 2018;9(2):160-70. [8] Gavrilovic A, Toncev G, Boskovic Matic T, Vesic K, Ilic Zivojinovic J, Gavrilovic J. Impact of epilepsy duration, seizure control and EEG abnormalities on cognitive impairment in drug-resistant epilepsy patients. Acta Neurol Belg 2019;119(3):403–10. [9] Wilson SJ, Baxendale S. Reprint of: The new approach to classification: rethinking cognition and behavior in epilepsy. Epilepsy Behav 2016;64:300–3. [10] Abou-Khalil BW. Update on antiepileptic drugs 2019: Contin lifelong. Learn Neurol 2019;25(2):508–36. [11] Breuer LEM, Bernas A, Boon P, Besseling RMH, Carrette ECB, de Louw A, et al. Accelerated cognitive ageing in epilepsy: a neuropsychological evaluation of cognitive deterioration. Arch Clin Neuropsychol. 2019;34(3):301-9. [12] Feldman L, Lapin B, Busch RM, Bautista JF. Evaluating subjective cognitive impairment in the adult epilepsy clinic: Effects of depression, number of antiepileptic medications, and seizure frequency. Epilepsy Behav 2018;81:18–24. [13] Baxendale S. Neuropsychological assessment in epilepsy. Pract Neurol 2018;18 (1):43–8. [14] Wandschneider B, Burdett J, Townsend L, Hill A, Thompson PJ, Duncan JS, et al. Effect of topiramate and zonisamide on fMRI cognitive networks. Neurology 2017;88(12):1165–71. [15] Antonio M-DJ, Viridiana S-Z, Alejandro M-M, Manuel S-MJ, Elena H-AM, Gonzalo A-A. Alteraciones cognitivas en la epilepsia. [16] Baxendale S, Wilson SJ, Baker GA, Barr W, Helmstaedter C, Hermann BP, et al. Indications and expectations for neuropsychological assessment in epilepsy surgery in children and adults: Report of the ILAE Neuropsychology Task Force Diagnostic Methods Commission: 2017–2021 Neuropsychological assessment in epilepsy surgery. Epileptic Disord 2019;21(3):221–34. [17] Jarcˇušková D, Palušná M, Gazda J, Feketeová E, Gdovinová Z. Which clinical and neuropsychological factors are responsible for cognitive impairment in patients with epilepsy? Int J Public Health 2020;65(6):947–56. [18] Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 - The Lancet Neurology [Internet]. [citado 15 de mayo de 2021]. Disponible en: https:// www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30499- X/fulltext. [19] Pedraza OL, Salazar AM, Sierra FA, Soler D, Castro J, Castillo P, et al. Confiabilidad, validez de criterio y discriminante del Montreal Cognitive Assessment (MoCA) test, en un grupo de adultos de Bogotá. Acta Médica Colomb 2016;41(4):221–8. [20] Ladino LD, Benjumea-Cuartas V, Calle-López Y, Orozco-Hernández JP, Castrillón-Velilla DM, López-González R, et al. Psychogenic nonepileptic seizures in Latin America: A survey describing current practices. Epilepsy Behav 2021;114:107150. [21] Peixoto-Santos JE, Blumcke I. Neuropathology of the 21th century for the Latin American epilepsy community. Seizure J Br Epilepsy Assoc [Internet] 2021. https://doi.org/10.1016/j.seizure.2021.02.003. 10 de febrero de 2021 [citado 17 de junio de 2021]; Disponible en: https://researcher-app.com/paper/ 6925071. [22] Carson N, Leach L, Murphy KJ. A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores: Re-examination of MoCA cutoff scores. Int J Geriatr Psychiatry 2018;33(2):379–88. [23] Gómez F, Zunzunegui M, Lord C, Alvarado B, García A. Applicability of the MoCA-S test in populations with little education in Colombia: MoCA-S in populations with little education. Int J Geriatr Psychiatry 2013;28(8):813–20. [24] Phabphal K, Kanjanasatien J. Montreal Cognitive Assessment in cryptogenic epilepsy patients with normal Mini-Mental State Examination scores. Epileptic Disord 2011;13(4):375–81. [25] Aguilar-Navarro SG, Mimenza-Alvarado AJ, Palacios-García AA, Samudio-Cruz A, Gutiérrez-Gutiérrez LA, Ávila-Funes JA. Validez y confiabilidad del MoCA (Montreal Cognitive Assessment) para el tamizaje del deterioro cognoscitivo en México. Rev Colomb Psiquiatr 2018;47(4):237–43. [26] Dong Y, Sharma VK, Chan B-L, Venketasubramanian N, Teoh HL, Seet RCS, et al. The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci 2010;299(1-2):15–8. [27] Malek-Ahmadi M, O’Connor K, Schofield S, Coon DW, Zamrini E. Trajectory and variability characterization of the Montreal cognitive assessment in older adults. Aging Clin Exp Res 2018;30(8):993–8. [28] Tsoi KKF, Chan JYC, Hirai HW, Wong SYS, Kwok TCY. Cognitive tests to detect dementia: A systematic review and meta-analysis. JAMA Intern Med. 2015;175(9):1450. [29] Thalheimer W, Cook S. How to calculate effect sizes from published research: A simplified methodology. Work-Learn Res 2002;1:1–9. [30] Rodrigues SG, Gouveia RG, Bentes C. MoCA as a cognitive assessment tool for absence status epilepticus. Epileptic Disord 2020;22(2):229–32. [31] de Souza MC, de Paulo CO, Miyashiro L, Twardowschy CA. Comparison of screening tests in the evaluation of cognitive status of patients with epilepsy. Dement Neuropsychol 2021;15(1):145–52. [32] He J, Xiao B, Liu C, Wang K, Tan LL. Feature of cognitive dysfunction in patients with temporal lobe epilepsy and its clinical influencing factors. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021;46(3):240–8. [33] Karaaslan Ö, Hamamcı M. Cognitive impairment profile differences in patients with psychogenic non-epileptic seizures and epilepsy patients with generalized seizures. Neurol Res 2020;42(3):179–88. [34] Lodhi S, Agrawal N. Neurocognitive problems in epilepsy. Adv Psychiatr Treat 2012;18(3):232–40. [35] Aldenkamp AP, Arends J. Effects of epileptiform EEG discharges on cognitive function: is the concept of ‘‘transient cognitive impairment” still valid? Epilepsy Behav 2004;5:25–34. [36] Yao X, Yu Q, Yang E, Ouyang H, Chen Y, Yang W, et al. Executive dysfunction in patients with temporal lobe epilepsy and its correlation with P300. Zhonghua Yi Xue Za Zhi 2014;94(7):521–4. [37] Baxendale S, Heaney D. Memory complaints in the epiltify clinic. Pract Neurol 2021;21(1):25–9. [38] Kumar VJ, Vatsala M. Cross sectional study to determine the cognitive impairments among epilepsy patients. Int J Res Med Sci 2019;7(5):1465–71. [39] Arango-Lasprilla JC, Stevens L, Morlett Paredes A, Ardila A, Rivera D. Profession of neuropsychology in Latin America. Appl Neuropsychol Adult 2017;24 (4):318–30. [40] Wang L, Chen S, Liu C, Lin W, Huang H. Factors for cognitive impairment in adult epileptic patients. Brain Behav 2020;10(1):e01475. [41] Taylor J, Baker GA. Newly diagnosed epilepsy: cognitive outcome at 5 years. Epilepsy Behav 2010;18(4):397–403. [42] Borda MG, Reyes-Ortiz C, Pérez-Zepeda MU, Patino-Hernandez D, GómezArteaga C, Cano-Gutiérrez CA. Educational level and its Association with the domains of the Montreal Cognitive Assessment Test. Aging Ment Health 2019;23(10):1300–6. [43] Miller LA, Galioto R, Tremont G, Davis J, Bryant K, Roth J, et al. Cognitive impairment in older adults with epilepsy: characterization and risk factor analysis. Epilepsy Behav 2016;56:113–7. [44] He J, Xiao B, Liu C, Wang K, Tan L, Long L. Feature of cognitive dysfunction in patients with temporal lobe epilepsy and its clinical influencing factors. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021;46(3):240–8. [45] Landi S, Petrucco L, Sicca F, Ratto GM. Transient cognitive impairment in epilepsy. Front Mol Neurosci 2019;11:458. [46] Nasreddine ZS, Phillips N, Chertkow H, Rossetti H, Lacritz L, Cullum M, et al. Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample Author Response. Neurology 2012;78(10):765–6. [47] Njamnshi AK, Chokote E-S, Ngarka L, Nfor LN, Tabah EN, Atchou JGB, et al. Epilepsy-associated neurocognitive disorders (EAND) in an onchocerciasisendemic rural community in Cameroon: A population-based case–control study. Epilepsy Behav 2020;112:107437. [48] Loureiro CCdS, García C, Adana L, Yacelga T, Rodríguez Lorenzana A, Maruta C. Uso del test de evaluación cognitiva de Montreal (MoCA) en América Latina: revisión sistemática. Rev Neurol 2018;66(12):397. |
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Epilepsy & Behavior |
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montaño-lozada, juan-manuelLópez, NormanESPEJO ZAPATA, LINA MARIASoto-Añari, MarcioRamos-Henderson, MiguelCaldichoury-Obando, NicoleCamargo, Loida2021-11-23T19:20:08Z2021-11-23T19:20:08Z202120221525-50501525-5069https://hdl.handle.net/11323/8900https://doi.org/10.1016/j.yebeh.2021.108158Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Introduction: Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains. Objective: To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpatient consultation at a reference diagnostic center in Colombia and analyze and the influencing factors. Materials and methodology: One-hundred and four patients during neurology outpatient consultation in the city of Cartagena, Colombia, were assessed with the (MoCA) test, i.e., 54 people who consulted for headache and have not been diagnosed with epilepsy (NEP) and 50 with a diagnosis of epilepsy (EPs) according to the diagnostic criteria of the International League Against Epilepsy (ILAE). Results: Significant differences were found in the total mean scores of the (MoCA) between (EPs) and (NPE) groups (t = 4.72; p < 0.01), particularly in attention (t = 3.22; p < 0.02) and memory (t = 5.04; p < 0.01) dimensions. Additionally, a significant association was observed between years of schooling and (MoCA) scores (p = 0,019) but not between socioeconomic level (p = 0,510), age (p = 0,452) and the frequency of seizures (p = 0,471). Discussion: Patients with epilepsy show lower scores in several cognitive domains in respect of the control group. The (MoCA) has proven its appropriateness for cognitive screening in the contexts of clinical neurology outpatient consultation.montaño-lozada, juan-manuel-will be generated-orcid-0000-0002-9747-2498-600López, NormanESPEJO ZAPATA, LINA MARIA-will be generated-orcid-0000-0003-1633-987X-600Soto-Añari, Marcio-will be generated-orcid-0000-0002-9121-3284-600Ramos-Henderson, Miguel-will be generated-orcid-0000-0003-1045-6872-600Caldichoury-Obando, NicoleCamargo, Loida-will be generated-orcid-0000-0003-0056-6832-600application/pdfengCorporación Universidad de la CostaCC0 1.0 Universalhttp://creativecommons.org/publicdomain/zero/1.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Epilepsy & Behaviorhttps://www.sciencedirect.com/science/article/pii/S1525505021004182?via%3DihubEpilepsyShort cognitive tests(MoCA) TestCognitive dysfunctionMental impairmentCognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultationPre-Publicaciónhttp://purl.org/coar/resource_type/c_816bTextinfo:eu-repo/semantics/preprinthttp://purl.org/redcol/resource_type/ARTOTRinfo:eu-repo/semantics/acceptedVersion[1] Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014;55 (4):475–82.[2] Michaelis R, Tang V, Goldstein LH, Reuber M, LaFrance WC, Lundgren T, et al. Psychological treatments for adults and children with epilepsy: Evidencebased recommendations by the International League Against Epilepsy Psychology Task Force. Epilepsia 2018;59(7):1282–302.[3] Aji BM, Larner AJ. Cognitive assessment in an epilepsy clinic using the AD8 questionnaire. Epilepsy Behav 2018;85:234–6.[4] Helmstaedter C, Witt J-A. Epilepsy and cognition–a bidirectional relationship? Seizure 2017;49:83–9.[5] Breuer LEM, Grevers E, Boon P, Bernas A, Bergmans JWM, Besseling RMH, et al. Cognitive deterioration in adult epilepsy: clinical characteristics of ‘‘Accelerated Cognitive Ageing”. Acta Neurol Scand 2017;136(1):47–53.[6] Falco-Walter JJ, Scheffer IE, Fisher RS. The new definition and classification of seizures and epilepsy. Epilepsy Res 2018;139:73–9.[7] Natham R, Amirthalingam P, Arunachalam G. Comparison of Montreal Cognitive Assessment (MOCA) with Mini Mental State Examination (MMSE) on association between homocysteine and cognitive status in epilepsy patients with phenytoin monotherapy. Asia Pac J Couns Psychother 2018;9(2):160-70.[8] Gavrilovic A, Toncev G, Boskovic Matic T, Vesic K, Ilic Zivojinovic J, Gavrilovic J. Impact of epilepsy duration, seizure control and EEG abnormalities on cognitive impairment in drug-resistant epilepsy patients. Acta Neurol Belg 2019;119(3):403–10.[9] Wilson SJ, Baxendale S. Reprint of: The new approach to classification: rethinking cognition and behavior in epilepsy. Epilepsy Behav 2016;64:300–3.[10] Abou-Khalil BW. Update on antiepileptic drugs 2019: Contin lifelong. Learn Neurol 2019;25(2):508–36.[11] Breuer LEM, Bernas A, Boon P, Besseling RMH, Carrette ECB, de Louw A, et al. Accelerated cognitive ageing in epilepsy: a neuropsychological evaluation of cognitive deterioration. Arch Clin Neuropsychol. 2019;34(3):301-9.[12] Feldman L, Lapin B, Busch RM, Bautista JF. Evaluating subjective cognitive impairment in the adult epilepsy clinic: Effects of depression, number of antiepileptic medications, and seizure frequency. Epilepsy Behav 2018;81:18–24.[13] Baxendale S. Neuropsychological assessment in epilepsy. Pract Neurol 2018;18 (1):43–8.[14] Wandschneider B, Burdett J, Townsend L, Hill A, Thompson PJ, Duncan JS, et al. Effect of topiramate and zonisamide on fMRI cognitive networks. Neurology 2017;88(12):1165–71.[15] Antonio M-DJ, Viridiana S-Z, Alejandro M-M, Manuel S-MJ, Elena H-AM, Gonzalo A-A. Alteraciones cognitivas en la epilepsia.[16] Baxendale S, Wilson SJ, Baker GA, Barr W, Helmstaedter C, Hermann BP, et al. Indications and expectations for neuropsychological assessment in epilepsy surgery in children and adults: Report of the ILAE Neuropsychology Task Force Diagnostic Methods Commission: 2017–2021 Neuropsychological assessment in epilepsy surgery. Epileptic Disord 2019;21(3):221–34.[17] Jarcˇušková D, Palušná M, Gazda J, Feketeová E, Gdovinová Z. Which clinical and neuropsychological factors are responsible for cognitive impairment in patients with epilepsy? Int J Public Health 2020;65(6):947–56.[18] Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 - The Lancet Neurology [Internet]. [citado 15 de mayo de 2021]. Disponible en: https:// www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30499- X/fulltext.[19] Pedraza OL, Salazar AM, Sierra FA, Soler D, Castro J, Castillo P, et al. Confiabilidad, validez de criterio y discriminante del Montreal Cognitive Assessment (MoCA) test, en un grupo de adultos de Bogotá. Acta Médica Colomb 2016;41(4):221–8.[20] Ladino LD, Benjumea-Cuartas V, Calle-López Y, Orozco-Hernández JP, Castrillón-Velilla DM, López-González R, et al. Psychogenic nonepileptic seizures in Latin America: A survey describing current practices. Epilepsy Behav 2021;114:107150.[21] Peixoto-Santos JE, Blumcke I. Neuropathology of the 21th century for the Latin American epilepsy community. Seizure J Br Epilepsy Assoc [Internet] 2021. https://doi.org/10.1016/j.seizure.2021.02.003. 10 de febrero de 2021 [citado 17 de junio de 2021]; Disponible en: https://researcher-app.com/paper/ 6925071.[22] Carson N, Leach L, Murphy KJ. A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores: Re-examination of MoCA cutoff scores. Int J Geriatr Psychiatry 2018;33(2):379–88.[23] Gómez F, Zunzunegui M, Lord C, Alvarado B, García A. Applicability of the MoCA-S test in populations with little education in Colombia: MoCA-S in populations with little education. Int J Geriatr Psychiatry 2013;28(8):813–20.[24] Phabphal K, Kanjanasatien J. Montreal Cognitive Assessment in cryptogenic epilepsy patients with normal Mini-Mental State Examination scores. 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