Using the Montreal Cognitive Assessment Test (MoCa) to screen for low cognitive performance in HIV positive heavy episodic alcohol users

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dc.contributor.advisorJoska, John
dc.contributor.advisorIpser, Jonathan
dc.contributor.authorOri, Rasmita
dc.date.accessioned2026-08-27T08:47:01Z
dc.date.available2026-08-27T08:47:01Z
dc.date.issued2026
dc.date.updated2026-08-27T08:45:46Z
dc.description.abstractBackground South Africa faces a dual public health crisis: concurrent HIV and high-risk alcohol consumption epidemics. Cognitive impairment in individuals with HIV (PLWH) is multifaceted, influenced by comorbidities and lifestyle factors. HIV infection correlates with increased alcohol use, potentially compromising treatment adherence and health outcomes. Globally, data on cognitive performance in PLWH with heavy episodic alcohol use are limited. Optimal assessment involves comprehensive neurocognitive testing with appropriate normative data; however, in resource-constrained settings, a concise, accessible screening tool administered by clinic staff is desirable. Early identification of at-risk individuals could enhance treatment outcomes and access to care. Given South Africa's resource limitations, this study investigates the utility of the Montreal Cognitive Assessment (MoCA) as a screening tool for detecting cognitive impairment in PLWH with heavy episodic drinking (HED) in Cape Town. Method: Sixty-six outpatients at Nolungile Clinic in Khayelitsha, Cape Town, underwent assessment encompassing sociodemographic data, MoCA and neuropsychological test battery scores, quantitative alcohol use, and clinical parameters. Participants were categorized into four groups based on HIV status and heavy alcohol consumption. Nonparametric Receiver Operating Characteristic (ROC) analysis determined the sensitivity and specificity of various MoCA cutoff scores against a gold-standard neurocognitive battery. Neurocognitive impairment was evaluated using the Global Deficit Score (GDS) and a novel multivariate method (NMM). Bivariate and chi-square tests identified associations between clinical variables and low cognitive performance. Results: The MoCA demonstrated high accuracy in differentiating participants with low cognitive performance, utilizing either the GDS (GDS; AUC = 0.901, 95% CI = 0.8090.992) or the NMM (NMM; AUC = 0.868, 95% CI = 0.766–0.969) to define low cognitive performance. Optimal MoCA cutoff scores were 19 (GDS) and 20 (NMM) with slightly lower specificity for the NMM (Sp = 0.661) compared to the GDS (Sp = 0.768), resulting in 19 false positives for the NMM and 13 for the GDS. At the standard MoCA cutoff of 26, 57 subjects (86.4%) were classified as having low cognitive performance. Using cutoff of 19 from ROC analysis, only 18 subjects (27.2%) were classified as impaired. Between group comparisons of low cognitive performance (HIV-/HED- = 5/19, HIV+/HED- = 6/18, HIV-/HED+ = 2/16, HIV+/HED+ = 5/13) revealed no significant difference (χ² = 2.923, df = 3, p = 0.404). MoCA cutoff scores showed no association with years of education or total socioeconomic status (SES) score. Similarly, no association was found between MoCA impairment and drinking score or HIV severity measures. Correlational analyses revealed a significant association between total MoCA score, SES, and NP domain scores (t = 2.436, df = 64, p = 0.01764). Significant associations were also observed for individual MoCA domains of naming and language with SES score. Low cognitive performance was significantly more prevalent in females (15/38 = 39.5%) than males (3/28 = 10.7%). Conclusion: This study demonstrates an association between lower cognitive performance and HIV, particularly among individuals with comorbid heavy alcohol use. This at-risk population would benefit from targeted screening to optimise treatment outcomes and access to dual diagnosis services. The MoCA maybe a valuable screening tool in resource constrained settings. Lowering the MoCA cutoff score further mitigates the overestimation of low cognitive performance. This research contributes to existing literature, showing a statistically significant association between SES score and both total MoCA score and specific cognitive domain impairment.
dc.identifier.apacitationOri, R. (2026). <i>Using the Montreal Cognitive Assessment Test (MoCa) to screen for low cognitive performance in HIV positive heavy episodic alcohol users</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Psychiatry and Mental Health. Retrieved from http://hdl.handle.net/11427/43725en_ZA
dc.identifier.chicagocitationOri, Rasmita. <i>"Using the Montreal Cognitive Assessment Test (MoCa) to screen for low cognitive performance in HIV positive heavy episodic alcohol users."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Psychiatry and Mental Health, 2026. http://hdl.handle.net/11427/43725en_ZA
dc.identifier.citationOri, R. 2026. Using the Montreal Cognitive Assessment Test (MoCa) to screen for low cognitive performance in HIV positive heavy episodic alcohol users. . University of Cape Town ,Faculty of Health Sciences ,Department of Psychiatry and Mental Health. http://hdl.handle.net/11427/43725en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Ori, Rasmita AB - Background South Africa faces a dual public health crisis: concurrent HIV and high-risk alcohol consumption epidemics. Cognitive impairment in individuals with HIV (PLWH) is multifaceted, influenced by comorbidities and lifestyle factors. HIV infection correlates with increased alcohol use, potentially compromising treatment adherence and health outcomes. Globally, data on cognitive performance in PLWH with heavy episodic alcohol use are limited. Optimal assessment involves comprehensive neurocognitive testing with appropriate normative data; however, in resource-constrained settings, a concise, accessible screening tool administered by clinic staff is desirable. Early identification of at-risk individuals could enhance treatment outcomes and access to care. Given South Africa's resource limitations, this study investigates the utility of the Montreal Cognitive Assessment (MoCA) as a screening tool for detecting cognitive impairment in PLWH with heavy episodic drinking (HED) in Cape Town. Method: Sixty-six outpatients at Nolungile Clinic in Khayelitsha, Cape Town, underwent assessment encompassing sociodemographic data, MoCA and neuropsychological test battery scores, quantitative alcohol use, and clinical parameters. Participants were categorized into four groups based on HIV status and heavy alcohol consumption. Nonparametric Receiver Operating Characteristic (ROC) analysis determined the sensitivity and specificity of various MoCA cutoff scores against a gold-standard neurocognitive battery. Neurocognitive impairment was evaluated using the Global Deficit Score (GDS) and a novel multivariate method (NMM). Bivariate and chi-square tests identified associations between clinical variables and low cognitive performance. Results: The MoCA demonstrated high accuracy in differentiating participants with low cognitive performance, utilizing either the GDS (GDS; AUC = 0.901, 95% CI = 0.8090.992) or the NMM (NMM; AUC = 0.868, 95% CI = 0.766–0.969) to define low cognitive performance. Optimal MoCA cutoff scores were 19 (GDS) and 20 (NMM) with slightly lower specificity for the NMM (Sp = 0.661) compared to the GDS (Sp = 0.768), resulting in 19 false positives for the NMM and 13 for the GDS. At the standard MoCA cutoff of 26, 57 subjects (86.4%) were classified as having low cognitive performance. Using cutoff of 19 from ROC analysis, only 18 subjects (27.2%) were classified as impaired. Between group comparisons of low cognitive performance (HIV-/HED- = 5/19, HIV+/HED- = 6/18, HIV-/HED+ = 2/16, HIV+/HED+ = 5/13) revealed no significant difference (χ² = 2.923, df = 3, p = 0.404). MoCA cutoff scores showed no association with years of education or total socioeconomic status (SES) score. Similarly, no association was found between MoCA impairment and drinking score or HIV severity measures. Correlational analyses revealed a significant association between total MoCA score, SES, and NP domain scores (t = 2.436, df = 64, p = 0.01764). Significant associations were also observed for individual MoCA domains of naming and language with SES score. Low cognitive performance was significantly more prevalent in females (15/38 = 39.5%) than males (3/28 = 10.7%). Conclusion: This study demonstrates an association between lower cognitive performance and HIV, particularly among individuals with comorbid heavy alcohol use. This at-risk population would benefit from targeted screening to optimise treatment outcomes and access to dual diagnosis services. The MoCA maybe a valuable screening tool in resource constrained settings. Lowering the MoCA cutoff score further mitigates the overestimation of low cognitive performance. This research contributes to existing literature, showing a statistically significant association between SES score and both total MoCA score and specific cognitive domain impairment. DA - 2026 DB - OpenUCT DP - University of Cape Town KW - HIV KW - alcohol consumption LK - https://open.uct.ac.za PB - University of Cape Town PY - 2026 T1 - Using the Montreal Cognitive Assessment Test (MoCa) to screen for low cognitive performance in HIV positive heavy episodic alcohol users TI - Using the Montreal Cognitive Assessment Test (MoCa) to screen for low cognitive performance in HIV positive heavy episodic alcohol users UR - http://hdl.handle.net/11427/43725 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/43725
dc.identifier.vancouvercitationOri R. Using the Montreal Cognitive Assessment Test (MoCa) to screen for low cognitive performance in HIV positive heavy episodic alcohol users. []. University of Cape Town ,Faculty of Health Sciences ,Department of Psychiatry and Mental Health, 2026 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43725en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Psychiatry and Mental Health
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectHIV
dc.subjectalcohol consumption
dc.titleUsing the Montreal Cognitive Assessment Test (MoCa) to screen for low cognitive performance in HIV positive heavy episodic alcohol users
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMPhil
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