Utilizing the MoCA test to discriminate the cognitive profile in temporal and frontal lobe epilepsies 

 

       Lama Rayyis, Adilah Al Turaifi, Sarah Alshehri, Mohammed AlMansour, Moath Basfer, Youssef Al Said, Fawzi Babtain 

Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia

 

Background: 

Temporal and frontal lobe epilepsies (TLE and FLE) are the most common focal epilepsies. While comprehensive neuropsychological testing is valuable for characterizing their distinct features and informing presurgical planning, it is time-consuming and resource-intensive. The Montreal Cognitive Assessment (MoCA) test is a brief cognitive tool assessing multiple domains. In this study, we evaluate the MoCA’s ability to distinguish the cognitive profiles between TLE and FLE. 

Methods:

We recruited patients with TLE or FLE who underwent pre-surgical evaluation, and reviewed their clinical data from medical records. We matched both groups for age, sex, and education. We administered the MoCA to all participants in clinic setting. We compared total MoCA scores and domain-specific subscores between groups. Additional analyses assessed the impact of epilepsy etiology, MRI findings, and age on cognitive profiles across subgroups.

 

Results: 

We studied 240 patients (106 FLE, 134 TLE) with a mean age of 31 years (range: 14-68), balanced sex distribution (120 males, 120 females), and predominantly right-handed individuals (90%). Median MoCA score was 23 (IQR: 21, 26).Total MoCA scores did not differ between FLE and TLE (p=0.17). However, key cognitive differences emerged in specific domains. The executive function subscore was significantly lower in FLE compared to TLE (mean: 3.29 vs. 3.70, p = 0.03), particularly in patients with an unknown etiology (p = 0.02) and those without a structural MRI abnormality (p = 0.03). Attention scores trended lower in FLE (mean: 4.02 vs. 4.40, p = 0.08), reaching significance in younger patients (<33 years) (p = 0.003) and those with an unknown etiology (p = 0.04). Memory recall, naming, language, and abstraction subscores did not significantly differ between groups (p > 0.05). 

 

Conclusion: 

Overall MoCA scores were similar between FLE and TLE. However, FLE was associated with greater executive dysfunction and reduced attention, particularly among younger patients and those with unknown etiology. These findings highlight the value of domain-specific cognitive assessment when characterizing cognitive profiles in focal epilepsies. Further evaluation with a larger sample size would help validate these findings and enhance our understanding of cognitive profiles in these epilepsies.