RESUMEN
Aims: In this study, we investigated if health professionals' evaluations of driving ability corresponded with measures of severity of alcohol use and measures of cognitive functions necessary for safely driving a car. Methods: A total of 90 participants from a multicentre study were included. Participants were categorised into three groups: (1) the group judged fit to drive (FIT); (2) the group judged not fit to drive (UNFIT); and (3) the group who had lost their driver's licence due to legal sanctions (LEGAL). The participants' AUDIT scores, earlier treatment episodes and results from neuropsychological tests of reaction time, attention and visuospatial ability were included in the analyses. Results: We found a significant difference in the severity of alcohol use disorder (AUD) and visuospatial abilities between the FIT and UNFIT groups. Half of the UNFIT group had at least mild visuospatial difficulties, compared to only a quarter in the FIT group. There were no group differences in reaction time or attentional measures. The LEGAL group had more severe AUD than the other groups. Conclusion: The FIT group did not perform differently from the UNFIT group on attention and reaction time measures. The UNFIT group had more visuospatial impairments, but even half of this group had normal scores. It is uncertain whether the differences between the two groups are of practical significance. The quality of health professionals' evaluations may be questioned, and the results highlight the need for more reliable and valid criteria for doing fitness to drive evaluations.
RESUMEN
BACKGROUND: Cognitive impairments are common in alcohol use disorder (AUD), but only a few studies have investigated the accuracy of the Montreal Cognitive Assessment (MoCA) in this population. We examined the accuracy and precision of the MoCA in detecting cognitive impairment in a sample of patients with AUD. In addition, we investigated whether the MoCA predicts premature discontinuation from treatment. METHOD: A sample of 126 persons with AUD undergoing treatment in specialist health services were administered the MoCA and a battery of 12 neuropsychological tests. Five cognitive domains were derived from the reference tests. A composite total score from these tests was used as a reference criterion for determining correct and incorrect classifications for the MoCA. We analyzed the optimal cut-off score for the MoCA and the accuracy and agreement of classification between the MoCA and the reference tests. RESULTS: Receiver operating characteristic (ROC) curve analyzes yielded an area under the curve (AUC) of 0.77 (95% CI [0.67, 0.87]). Applying 25 as the cut-off, MoCA sensitivity was 0.77 and specificity 0.62. The PPV was 0.53. The NPV was 0.84. Using a cut-off score of 24 yielded a lower sensitivity 0.60, but specificity was significantly better i.e., 0.79. PPV was 0.68. The NPV was 0.82. Kappa agreement between MoCA and the reference tests was fair to moderate, 0.38 for the cut-off of 25, and 0.44 for the cut-off of 24. MoCA did not predict discontinuation from treatment. CONCLUSIONS: Our findings indicate limitations in the classification accuracy of the MoCA in predicting cognitive impairment in AUD. Achieving the right balance between accurately identifying impaired cases without including too many false positives can be challenging. Further, MoCA does not predict discontinuation from treatment. Overall, the results do not support MoCA as a time-efficient screening instrument.