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01-12-2020 | Multiple Sclerosis | Review article

Montreal cognitive assessment for evaluating cognitive impairment in multiple sclerosis: a systematic review

Authors: Elena Cecilia Rosca, Mihaela Simu

Published in: Acta Neurologica Belgica | Issue 6/2020

Abstract

This study aims to systematically review the evidence on the accuracy of the Montreal Cognitive Assessment (MoCA) test for evaluating the presence of cognitive impairment in patients with multiple sclerosis (MS) and to outline the quality and quantity of research evidence available about the use of MoCA in this population. We conducted a systematic literature review, searching five databases from inception until May 2020. We identified fourteen studies that met the inclusion criteria: three cross-sectional studies and two case – control studies comparing MoCA to a battery of tests, one study comparing MoCA to Mini-Mental State Examination (MMSE), and eight studies estimating the prevalence of cognitive impairment in individuals with MS. Publication period ranged from 2012 to 2020. Although the MoCA test demonstrated good sensitivity and specificity when used at the recommended threshold of 26, a lower threshold than the original cut-off was also reported to be useful for optimal screening, as it lowers false positive rates and improves diagnostic accuracy. Furthermore, in MS patients without subjective cognitive complaints, a cutoff of 27 could provide a better balance between the sensitivity and the specificity of the test. In patients with MS, the MoCA provides information on general cognitive functions disturbances. Nonetheless, more studies are required to examine the optimum cut-off score for detecting cognitive impairments in MS patients.

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Trapp BD, Ransohoff R, Rudick R (1999) Axonal pathology in multiple sclerosis: relationship to neurologic disability. Curr Opin Neurol 12:295–302. https://doi.org/10.1097/00019052-199906000-00008CrossRef

Chiaravalloti ND, DeLuca J (2008) Cognitive impairment in multiple sclerosis. Lancet Neurol 7:1139–1151. https://doi.org/10.1016/S1474-4422(08)70259-XCrossRef

Zhang X, Zhang F, Huang D et al (2017) Contribution of gray and white matter abnormalities to cognitive impairment in multiple sclerosis. Int J Mol Sci 18(1):46. https://doi.org/10.3390/ijms18010046CrossRef

Rao SM, Leo GJ, Bernardin L, Unverzagt F (1991) Cognitive dysfunction in multiple sclerosis: frequency, patterns, and prediction. Neurology 41:685–691. https://doi.org/10.1212/wnl.41.5.685CrossRef

Sumowski JF, Benedict R, Enzinger C, Filippi M, Geurts JJ, Hamalainen P et al (2018) Cognition in multiple sclerosis: state of the field and priorities for the future. Neurology 90:278–288. https://doi.org/10.1212/WNL.0000000000004977CrossRef

Amato MP, Ponziani G, Siracusa G et al (2001) Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. Arch Neurol 58:1602–1606. https://doi.org/10.1001/archneur.58.10.1602CrossRef

Amato MP, Razzolini L, Goretti B et al (2013) Cognitive reserve and cortical atrophy in multiple sclerosis: a longitudinal study. Neurology 80:1728–1733. https://doi.org/10.1212/WNL.0b013e3182918c6fCrossRef

Lacy M, Hauser M, Pliskin N et al (2013) The effects of long-term interferon-beta-1b treatment on cognitive functioning in multiple sclerosis: a 16-year longitudinal study. Mult Scler 19:1765–1772. https://doi.org/10.1177/1352458513485981CrossRef

Achiron A, Chapman J, Magalashvili D, Dolev M, Lavie M, Bercovich E et al (2013) Modeling of cognitive impairment by disease duration in multiple sclerosis: a cross-sectional study. PLoS ONE 8:e71058. https://doi.org/10.1371/journal.pone.0071058CrossRef

10.

Brochet B, Ruet A (2019) Cognitive impairment in multiple sclerosis with regards to disease duration and clinical phenotypes. Front Neurol 10:261. https://doi.org/10.3389/fneur.2019.00261CrossRef

11.

Kalb R, Beier M, Benedict RH et al (2018) Recommendations for cognitive screening and management in multiple sclerosis care. Mult Scler 24(13):1665–1680. https://doi.org/10.1177/1352458518803785CrossRef

12.

Amato MP, Portaccio E, Goretti B et al (2010) Relevance of cognitive deterioration in early relapsing remitting MS: a 3-year follow-up study. Mult Scler 16:1474–1482. https://doi.org/10.1177/1352458510380089CrossRef

13.

Lebrun C, Blanc F, Brassat D, Zephir H, de Seze J, CFSEP (2010) Cognitive function in radiologically isolated syndrome. Mult Scler 16:919–925. https://doi.org/10.1177/1352458510375707CrossRef

14.

Amato MP, Hakiki B, Goretti B, Rossi F, Stromillo ML, Giorgio A et al (2012) Association of MRI metrics and cognitive impairment in radiologically isolated syndromes. Neurology 78:309–314. https://doi.org/10.1212/WNL.0b013e31824528c9CrossRef

15.

Khalil M, Enzinger C, Langkammer C, Petrovic K, Loitfelder M, Tscherner M et al (2011) Cognitive impairment in relation to MRI metrics in patients with clinically isolated syndrome. Mult Scler 17:173–180. https://doi.org/10.1177/1352458510384009CrossRef

16.

Reuter F, Zaaraoui W, Crespy L, Faivre A, Rico A, Malikova I et al (2011) Cognitive impairment at the onset of multiple sclerosis: relationship to lesion location. Mult Scler 17:755–758. https://doi.org/10.1177/1352458511398265CrossRef

17.

Panou T, Mastorodemos V, Papadaki E, Simos PG, Plaitakis A (2012) Early signs of memory impairment among multiple sclerosis patients with clinically isolated syndrome. Behav Neurol 25:311–326. https://doi.org/10.1155/2012/105471CrossRef

18.

Ruano L, Portaccio E, Goretti B, Niccolai C, Severo M, Patti F et al (2017) Age and disability drive cognitive impairment in multiple sclerosis across disease subtypes. Mult Scler 23:1258–1267. https://doi.org/10.1177/1352458516674367CrossRef

19.

Koubiyr I, Deloire M, Besson P et al (2020) Longitudinal study of functional brain network reorganization in clinically isolated syndrome. Mult Scler 26(2):188–200. https://doi.org/10.1177/1352458518813108CrossRef

20.

Planche V, Gibelin M, Cregut D, Pereira B, Clavelou P (2016) Cognitive impairment in a population-based study of patients with multiple sclerosis: differences between late relapsing-remitting, secondary progressive and primary progressive multiple sclerosis. Eur J Neurol 23:282–289. https://doi.org/10.1111/ene.12715CrossRef

21.

Camp SJ, Stevenson VL, Thompson AJ, Miller DH, Borras C, Auriacombe S et al (1999) Cognitive function in primary progressive and transitional progressive multiple sclerosis: a controlled study with MRI correlates. Brain 122(7):1341–1348. https://doi.org/10.1093/brain/122.7.1341CrossRef

22.

Potagas C, Giogkaraki E, Koutsis G, Mandellos D, Tsirempolou E, Sfagos C et al (2008) Cognitive impairment in different MS subtypes and clinically isolated syndromes. J Neurol Sci 267:100–106. https://doi.org/10.1016/j.jns.2007.10.002CrossRef

23.

Ruet A, Deloire M, Charré-Morin J, Hamel D, Brochet B (2013) Cognitive impairment differs between primary progressive and relapsing-remitting MS. Neurology 80:1501–1508. https://doi.org/10.1212/WNL.0b013e31828cf82fCrossRef

24.

Morrow SA, Jurgensen S, Forrestal F et al (2011) Effects of acute relapses on neuropsychological status in multiple sclerosis patients. J Neurol 258:1603–1608. https://doi.org/10.1007/s00415-011-5975-3CrossRef

25.

Pardini M, Uccelli A, Grafman J et al (2014) Isolated cognitive relapses in multiple sclerosis. J Neurol Neurosurg Psychiatry 85:1035–1037. https://doi.org/10.1136/jnnp-2013-307275CrossRef

26.

Benedict R, DeLuca J, Phillips G, LaRocca N, Hudson LD, Rudick R, Multiple Sclerosis Outcome Assessments Consortium (2017) Validity of the symbol digit modalities test as a cognition performance outcome measure for multiple sclerosis. Mult Scler 23:721–733. https://doi.org/10.1177/1352458517690821CrossRef

27.

Benedict RHB, Cookfair D, Gavett R et al (2006) Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). J Int Neuropsychol Soc 12:549–558. https://doi.org/10.1017/s1355617706060723CrossRef

28.

Rao SM, Losinski G, Mourany L et al (2017) Processing speed test: validation of a self-administered, iPad®-based tool for screening cognitive dysfunction in a clinic setting. Mult Scler 23:1929–1937. https://doi.org/10.1177/1352458516688955CrossRef

29.

Ruet A, Deloire MSA, Charré-Morin J et al (2013) A new computerised cognitive test for the detection of information processing speed impairment in multiple sclerosis. Mult Scler 19:1665–1672. https://doi.org/10.1177/1352458513480251CrossRef

30.

Benedict RHB, Cox D, Thompson LL et al (2004) Reliable screening for neuropsychological impairment in multiple sclerosis. Mult Scler 10:675–678. https://doi.org/10.1191/1352458504ms1098oaCrossRef

31.

O’Brien A, Gaudino-Goering E, Shawaryn M et al (2007) Relationship of the multiple sclerosis neuropsychological questionnaire (MSNQ) to functional, emotional, and neuropsychological outcomes. Arch Clin Neuropsychol 22:933–948. https://doi.org/10.1016/j.acn.2007.07.002CrossRef

32.

Akbar N, Honarmand K, Feinstein A (2011) Self-assessment of cognition in multiple sclerosis: the role of personality and anxiety. Cogn Behav Neurol 24:115–121. https://doi.org/10.1097/WNN.0b013e31822a20aeCrossRef

33.

Langdon DW, Amato MP, Boringa J et al (2012) Recommendations for a brief international cognitive assessment for multiple sclerosis (BICAMS). Mult Scler 18:891–898. https://doi.org/10.1177/1352458511431076CrossRef

34.

Klein OA, das Nair R, Ablewhite J, Drummond A (2019) Assessment and management of cognitive problems in people with multiple sclerosis: a national survey of clinical practice. Int J Clin Pract 73:e13300. https://doi.org/10.1111/ijcp.13300CrossRef

35.

Paul S, Brown A, Hughes AJ (2019) Cognitive assessment of individuals with multiple sclerosis in the Arab world: a systematic review. Neuropsychol Rev 29:259–269. https://doi.org/10.1007/s11065-019-09408-5CrossRef

36.

Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.xCrossRef

37.

Costa AS, Fimm B, Friesen P, Soundjock H, Rottschy C, Gross T, Eitner F, Reich A, Schulz JB, Nasreddine ZS, Reetz K (2012) Alternate-form reliability of the montreal cognitive assessment screening test in a clinical setting. Dement Geriatr Cogn Disord 33(6):379–384. https://doi.org/10.1159/000340006CrossRef

38.

Ismail Z, Rajji TK, Shulman KI (2010) Brief cognitive screening instruments: an update. Int J of Geriatr Psychiatry 25(2):111–120. https://doi.org/10.1002/gps.2306CrossRef

39.

Freitas S, Simoes MR, Alves L, Santana I (2013) Montreal cognitive assessment: validation study for mild cognitive impairment and alzheimer disease. Alzheimer Dis Assoc Disord 27(1):37–43. https://doi.org/10.1097/WAD.0b013e3182420bfeCrossRef

40.

Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB, Weintraub D (2009) Validity of the MoCA and MMSE in the detection of MCI and dementia in parkinson disease. Neurology 73(21):1738–1745. https://doi.org/10.1212/WNL.0b013e3181e7948aCrossRef

41.

Bezdicek O, Majerova V, Novak M, Nikolai T, Ruzicka E, Roth J (2013) Validity of the montreal cognitive assessment in the detection of cognitive dysfunction in huntington's disease. Appl Neuropsychol Adult 20(1):33–40. https://doi.org/10.1080/09084282.2012.670158CrossRef

42.

Lees R, Selvarajah J, Fenton C, Pendlebury ST, Langhorne P, Stott DJ, Quinn TJ (2014) Test accuracy of cognitive screening tests for diagnosis of dementia and multidomain cognitive impairment in stroke. Stroke 45(10):3008–3018. https://doi.org/10.1161/STROKEAHA.114.005842CrossRef

43.

Davis DH, Creavin ST, Yip JL, Noel-Storr AH, Brayne C, Cullum S (2015) Montreal cognitive assessment for the diagnosis of Alzheimer's disease and other dementias. Cochrane Database Syst Rev 10:CD010775. https://doi.org/10.1002/14651858.CD010775.pub2CrossRef

44.

Carson N, Leach L, Murphy KJ (2018) A re-examination of montreal cognitive assessment (MoCA) cutoff scores. Int J Geriatr Psychiatry 33(2):379–388. https://doi.org/10.1002/gps.4756CrossRef

45.

Rosca EC, Albarqouni L, Simu M (2019) Montreal cognitive assessment (MoCA) for HIV-associated neurocognitive disorders. Neuropsychol Rev 29(3):313–327. https://doi.org/10.1007/s11065-019-09412-9CrossRef

46.

Rosca EC, Cornea A, Simu M (2020) Montreal cognitive assessment for evaluating the cognitive impairment in patients with schizophrenia: a systematic review. Gen Hosp Psychiatry 65:64–73. https://doi.org/10.1016/j.genhosppsych.2020.05.011CrossRef

47.

Rocca MA, Amato MP, De Stefano N et al (2015) Clinical and imaging assessment of cognitive dysfunction in multiple sclerosis. Lancet Neurol 14:302–317. https://doi.org/10.1016/S1474-4422(14)70250-9CrossRef

48.

Benedict RH, Morrow S, Rodgers J et al (2014) Characterizing cognitive function during relapse in multiple sclerosis. Mult Scler 20:1745–1752. https://doi.org/10.1177/1352458514533229CrossRef

49.

Fenu G, Fronza M, Lorefice L, Arru M, Coghe G, Frau J et al (2018) Performance in daily activities, cognitive impairment and perception in multiple sclerosis patients and their caregivers. BMC Neurol 18(1):212. https://doi.org/10.1186/s12883-018-1224-zCrossRef

50.

Goretti B, Portaccio E, Zipoli V, Hakiki B, Siracusa G, Sorbi S et al (2009) Coping strategies, psychological variables and their relationship with quality of life in multiple sclerosis. Neurol Sci 30(1):15–20. https://doi.org/10.1007/s10072-008-0009-3CrossRef

51.

Goverover Y, Chiaravalloti ND, O'Brien AR, DeLuca J (2018) Evidenced-based cognitive rehabilitation for persons with multiple sclerosis: An updated review of the literature from 2007 to 2016. Arch Phys Med Rehabil 99(2):390–407. https://doi.org/10.1016/j.apmr.2017.07.021CrossRef

52.

Niccolai C, Goretti B, Amato MP (2017) Disease modifying treatments and symptomatic drugs for cognitive impairment in multiple sclerosis: where do we stand? Mult Scler Demyelinating Disord 2:8. https://doi.org/10.1186/s40893-017-0025-3CrossRef

53.

Handbook for Diagnostic Test Accuracy Reviews. https://methods.cochrane.org/sdt/handbook-dta-reviews . Accessed 18 April 2020.

54.

Moher D, Liberati A, Tetzlaff J, Altman DG, the PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097CrossRef

55.

Polman CH, Reingold SC, Edan G et al (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann Neurol 58(6):840–846. https://doi.org/10.1002/ana.20703CrossRef

56.

Campbell JM, Klugar M, Ding S, Carmody D, Hakonsen SJ, Jadotte YT et al (2015) Diagnostic test accuracy. Int J Evid Based Healthc 13(3):154–162. https://doi.org/10.1097/XEB.0000000000000061CrossRef

57.

Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536. https://doi.org/10.7326/0003-4819-155-8-201110180-00009CrossRef

58.

Dagenais E, Rouleau I, Demers M et al (2013) Value of the MoCA test as a screening instrument in multiple sclerosis. Can J Neurol Sci 40(3):410–415. https://doi.org/10.1017/s0317167100014384CrossRef

59.

Gomez-Moreno SM, Cuadrado ML, Cruz-Orduña I et al (2020) Validation of the Spanish-language version of the montreal cognitive assessment as a screening test for cognitive impairment in multiple sclerosis. Neurologia S0213–4853(19):30149–30155. https://doi.org/10.1016/j.nrl.2019.11.006CrossRef

60.

Charest K, Tremblay A, Langlois R, Roger É, Duquette P, Rouleau I (2020) Detecting subtle cognitive impairment in multiple sclerosis with the MoCA test. Can J Neurol Sci. https://doi.org/10.1017/cjn.2020.97CrossRef

61.

Freitas S, Batista S, Afonso AC et al (2018) The montreal cognitive assessment (MoCA) as a screening test for cognitive dysfunction in multiple sclerosis. Appl Neuropsychol Adult 25(1):57–70. https://doi.org/10.1080/23279095.2016.1243108CrossRef

62.

Konstantopoulos K, Vogazianos P (2019) Montreal cognitive assessment in a Greek sample of patients with multiple sclerosis: a validation study. Appl Neuropsychol Adult. https://doi.org/10.1080/23279095.2019.1588123CrossRef

63.

Ahmadi MA, Ashrafi F, Behnam B (2015) Comparison of montreal cognitive assessment test and mini mental state examination in detecting cognitive impairment in relapsing-remitting multiple sclerosis patients. Int Clin Neurosci J 2(4):137–141. https://doi.org/10.22037/icnj.v2i4.11665CrossRef

64.

Abraham PK, Rege PV (2012) A study of cognitive impairments in multiple sclerosis: occupational therapy perspective. Indian J Occup Ther 44(1):2–12

65.

Aksoy S, Timer E, Mumcu S et al (2013) Screening for cognitive impairment in multiple sclerosis with MOCA test. Turk Noroloji Dergisi 19(2):52–55. https://doi.org/10.4274/Tnd.86570CrossRef

66.

Billore NS, Kumar G, Kaur D, Singh AK (2014) Screening cognitive impairments in Indian ms patients through oral version of symbol digit modality test and montreal cognitive assessment test. Mult Scler 20(7):918. https://doi.org/10.1177/1352458514531864CrossRef

67.

Lopez GR, Leal IRO, Perodin MP (2014) cognitive changes on the multiple sclerosis. Revista del Hospital Psiquiatrico de la Habana 11(2). https://www.scopus.com

68.

Charvet LE, Taub E, Cersosimo B et al (2015) The montreal cognitive assessment (MoCA) in multiple sclerosis: relation to clinical features. J Mult Scler 2:2. https://doi.org/10.4172/2376-0389.1000135CrossRef

69.

Sengul HS, Sengül Y, Yücel S, Forta H (2016) Cognitive impairment in young multiple sclerosis and essential tremor patients: a comparative study. Turk Noroloji Dergisi 22(3):109–113. https://doi.org/10.4274/tnd.46704CrossRef

70.

Tag El-Din E-SA, Bahnasy WS, Rashed KH et al (2016) Cognitive functions in multiple sclerosis patients. Egypt J Neurol Psychiatr Neurosurg 53(3):168–173. https://doi.org/10.4103/1110-1083.193067CrossRef

71.

Ganieva I, Parpieva Y, Khalimova K, Yakubova M (2019) The study of the of cognitive disfunctions using to the test “MoCa” in patients with multiple sclerosis. J Neurol Sci 405:284. https://doi.org/10.1016/j.jns.2019.10.1355CrossRef

72.

Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J (2004) Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med 140:189–202. https://doi.org/10.7326/0003-4819-140-3-200402030-00010CrossRef

73.

Del Ser T, Sanchez-Sanchez F, Garcia de Yebenes MJ, Otero A, Munoz DG (2006) Validation of the seven-minute screen neurocognitive battery for the diagnosis of dementia in a Spanish population-based sample. Dement Geriatr Cogn Disord 22:454–464. https://doi.org/10.1159/000095858CrossRef

74.

Bezdıcek O, Balabanova P, Havrankova P, Stochl J, Roth J, Ruzicka E (2010) Comparison of the Czech version of the montreal cognitive assessment test with the mini-mental state examination in identifying cognitive deficits in parkinson’s disease. Czech and Slovak Neurology and Neurosurgery 73:150–156. https://www.csnn.eu/en/journals/czech-and-slovak-neurology-and-neurosurgery/2010-2/a-comparison-of-the-czech-version-of-the-montreal-cognitive-assessment-test-with-the-mini-mental-state-examination-in-identifying-cognitive-deficits-in-parkinsons-disease-33828Accessed 26 Sept (2020)

75.

Julayanont P, Phillips N, Chertkow H, Nasreddine ZS (2013) Montreal Cognitive Assessment (MoCA): Concept and Clinical Review. In: Larner A (ed) Cognitive Screening Instruments. Springer, London, pp 111–151. https://doi.org/10.1007/978-1-4471-2452-8_6CrossRef

76.

Novo AM, Batista S, Tenente J et al (2016) Apathy in multiple sclerosis: gender matters. J Clin Neurosci 33:100–104. https://doi.org/10.1016/j.jocn.2016.02.038CrossRef

77.

Cehelyk EK, Harvey DY, Grubb ML et al (2019) Uncovering the association between fatigue and fatigability in multiple sclerosis using cognitive control. Mult Scler Relat Disord 27:269–275. https://doi.org/10.1016/j.msard.2018.10.112CrossRef

78.

Khalil H, Al-Shorman A, El-Salem K et al (2017) Fear of falling in people with multiple sclerosis: which clinical characteristics are important? Phys Ther 97(7):698–706. https://doi.org/10.1093/ptj/pzx044CrossRef

79.

Vacaras V, Major ZZ, Seewooram R, Major KA, Muresanu DF, Buzoianu AD (2014) Disease activity and disability evolution under glatiramer acetate: a clinical approach. Neuropsychopharmacol Hung 16(1):11–18 (PMID: 24687014)

80.

Berkovich R (2017) Effects of alemtuzumab on disability and cognition in patients with secondary progressive multiple sclerosis (SPMS). Neurology 88(Suppl 16):P5.356

81.

Darwish H, Haddad R, Osman S et al (2017) Effect of vitamin D replacement on cognition in multiple sclerosis patients. Sci Rep 7:45926. https://doi.org/10.1038/srep45926CrossRef

82.

Yahno NN, Fedotova AV (2017) Post-marketing observational program of the effectiveness of fluvoxamine for the treatment of depression in patients with neurological disorders: the FRIENDS study. Neuropsychiatr Dis Treat 13:2747–2756. https://doi.org/10.2147/NDT.S145614CrossRef

83.

Chaves AR, Wallack EM, Kelly LP et al (2019) Asymmetry of brain excitability: a new biomarker that predicts objective and subjective symptoms in multiple sclerosis. Behav Brain Res 359:281–291. https://doi.org/10.1016/j.bbr.2018.11.005CrossRef

Title: Montreal cognitive assessment for evaluating cognitive impairment in multiple sclerosis: a systematic review
Authors: Elena Cecilia Rosca
Mihaela Simu
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keyword: Multiple Sclerosis
Published in: Acta Neurologica Belgica / Issue 6/2020
Print ISSN: 0300-9009
Electronic ISSN: 2240-2993
DOI: https://doi.org/10.1007/s13760-020-01509-w

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Montreal cognitive assessment for evaluating cognitive impairment in multiple sclerosis: a systematic review

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