Remote assessments have become more popular post-pandemic, and the MoCA (Montreal Cognitive Exam) is no exception.  The MoCA is validated in clinic for assessment of cognitive function but disease specific validation for remote assessments has not yet been done. A test which is validated has been tested to make sure it measures what it is supposed to measure, and that the results of the test are both reliable and useful. Remote assessments are liked by both patients and practitioners for several reasons:

Remote testing allows for easy administration at short notice.

Remote testing makes the assessment accessible for patients who often have mobility issues.

Remote administration of the MoCA can allow a patient to avoid the cost of travel to a clinic, especially if they’re in a rural area or live far from a neurological specialist.

These are some of the ways that remote testing may fill the gap formerly only possible in clinic visits. Picciotto and colleagues validated the use of a modified remote MoCA for patients with cerebellar ataxia.

We can’t assume, without testing, that remote assessments work the same as in-person assessments. They also cannot be assumed to be valid for every illness. The researchers found that the MoCA-VC (MoCA Video Conferencing) they designed was valid, reliable, and generalizable when compared to MoCAs administered in person. They also compared MoCAs and MoCA-VCs administered to healthy people and people with cerebellar ataxia. This allowed the researchers to investigate whether the test reflected calculated average scores from previous studies. The study determined that the MoCA-VC is a valid screening tool for people with cerebellar ataxia.

There were three parts to this study:

First, the researchers reviewed previous findings comparing in-person MoCA scores between large samples of people without ataxia and those with cerebellar ataxia.

Second, they assessed a group of people without ataxia and those with cerebellar ataxia with an in-person MoCA. This was done to generate their own controlled data regarding average results.

Finally, they administered the MoCA-VC to healthy people and to a large group of people with cerebellar ataxia.

Using the data gathered, researchers were able to determine that there were no performance differences between groups taking the MoCA versus the MoCA-VC. This was true for both the healthy and cerebellar ataxia groups. This indicates that the MoCA is generally reliable across in-person and online formats.

The first two steps also generated average MoCA scores across healthy and cerebellar ataxia groups, which were compared to the average MoCA-VC scores. The scores were similar to each other.  This means that the MoCA-VC is not only on par with the MoCA but can effectively assess mild cognitive impairment in patients with cerebellar ataxia.

Overall, this study opens the door for MoCA-VCs to be used in a clinical and research setting. This could make these assessments far more accessible and comfortable for patients. A limitation is that this is a single-center study, meaning it was only done in one location. We’ll have greater confidence in the results once other researchers in other parts of the world see similar findings.  Cognitive symptoms are not often studied in ataxia clinical research. We hope that this tool helps more people with cerebellar ataxia participate in research studies, which would be monumental. Movement symptoms may make travel or regular in-person assessments difficult. Creating remote testing options will hopefully make clinical and research participation easier. This means more research on cerebellar ataxia, easier disease monitoring, and earlier detection of mild cognitive impairment.