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Correcting the MoCA for Education: Effect on Sensitivity

Published online by Cambridge University Press:  23 September 2014

Genevieve Gagnon ,
Kevin T. Hansen ,
Sarah Woolmore-Goodwin ,
Iris Gutmanis ,
Jennie Wells ,
Michael Borrie  and
Jennifer Fogarty
Genevieve Gagnon
Affiliation:
Centre for Addiction and Mental Health, University of Toronto, Toronto Department of Psychiatry, University of Toronto, Toronto
Kevin T. Hansen
Affiliation:
Specialized Geriatric Services, St. Joseph's Health Care, London
Sarah Woolmore-Goodwin
Affiliation:
Specialized Geriatric Services, St. Joseph's Health Care, London
Iris Gutmanis
Affiliation:
Lawson Health Research Institute, St. Joseph's Health Care, London Specialized Geriatric Services, St. Joseph's Health Care, London Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario Faculty of Medicine, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario
Jennie Wells
Affiliation:
Lawson Health Research Institute, St. Joseph's Health Care, London Specialized Geriatric Services, St. Joseph's Health Care, London Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario
Michael Borrie
Affiliation:
Lawson Health Research Institute, St. Joseph's Health Care, London Specialized Geriatric Services, St. Joseph's Health Care, London Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario Consortium of Canadian Centres for Clinical Cognitive Research (C5R), Calgary, Alberta, Canada
Jennifer Fogarty*
Affiliation:
Lawson Health Research Institute, St. Joseph's Health Care, London Specialized Geriatric Services, St. Joseph's Health Care, London Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario
*
St. Joseph's Health Care London, 801 Commissioners Road East, London, Ontario, N6C 5J1, Canada. Email: jennifer.fogarty@sjhc.london.on.ca
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Abstract:

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Objective:

The goal of this study was to quantify the impact of the suggested education correction on the sensitivity and specificity of the Montreal Cognitive Assessment (MoCA).

Method:

Twenty-five outpatients with dementia and 39 with amnestic mild cognitive impairment (aMCI) underwent a diagnostic evaluation, which included the MoCA. Thirty-seven healthy controls also completed the MoCA and psychiatric, medical, neurological, functional, and cognitive difficulties were ruled out.

Results:

For the total MoCA score, unadjusted for education, a cut-off score of 26 yielded the best balance between sensitivity and specificity (80% and 89% respectively) in identifying cognitive impairment (people with either dementia or aMCI, versus controls). When applying the education correction, sensitivity decreased from 80% to 69% for a small specificity increase (89% to 92%). The cut-off score yielding the best balance between sensitivity and specificity for the education adjusted MoCA score fell to 25 (61% and 97%, respectively).

Conclusions:

Adjusting the MoCA total score for education had a detrimental effect on sensitivity with only a slight increase in specificity. Clinically, this loss in sensitivity can lead to an increased number of false negatives, as education level does not always correlate to premorbid intellectual function. Clinical judgment about premorbid status should guide interpretation. However, as this effect may be cohortspecific, age and education corrected norms and cut-offs should be developed to help guide MoCA interpretation.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 5 , September 2013 , pp. 678 - 683
Copyright
Copyright © The Canadian Journal of Neurological 2013

References

1.Nasreddine, ZS, Phillips, NA, Bedirian, V, et al.The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.Google Scholar
2.Petersen, RC.Clinical practice. Mild cognitive impairment. N Engl J Med. 2011;364(23):2227–34.Google Scholar
3.Petersen, RC.Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256(3):183–94.Google Scholar
4.Petersen, RC, Stevens, JC, Ganguli, M, Tangalos, EG, Cummings, JL, DeKosky, ST.Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1133–42.Google Scholar
5.Morgan, DG, Crossley, M, Kirk, A, et al.Improving access to dementia care: development and evaluation of a rural and remote memory clinic. Aging Ment Health. 2009;13(1):17–30.CrossRefGoogle ScholarPubMed
6.Folstein, MF, Folstein, SE, McHugh, PR.“Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefGoogle ScholarPubMed
7.Hoops, S, Nazem, S, Siderowf, AD, et al.Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology. 2009;73(21):1738–45.Google Scholar
8.Videnovic, A, Bernard, B, Fan, W, Jaglin, J, Leurgans, S, Shannon, KM.The Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in Huntington's disease. Mov Disord. 2010;25(3):401–4.Google Scholar
9.Bernstein, IH, Lacritz, L, Barlow, CE, Weiner, MF, DeFina, LF.Psychometric evaluation of the Montreal Cognitive Assessment (MoCA) in three diverse samples. Clin neuropsychol. 2011;25(1):119–26.Google Scholar
10.Johns, E, Phillips, NA, Chertkow, H, et al.The Montreal Cognitive Assessment: normative data in the community. J Int Neuropsychol Soc. 2008;14 Suppl 1:i–292.Google Scholar
11.Phillips, NA, Johns, E, Chertkow, H, et al.The Montreal Cognitive Assessment (MoCA): normative data in the community. Can Geriatr J. 2008;11:62.Google Scholar
12.Tervo, S, Kivipelto, M, Hanninen, T, et al.Incidence and risk factors for mild cognitive impairment: a population-based three-year follow-up study of cognitively healthy elderly subjects. Dement Geriatr Cogn Disord. 2004;17(3):196–203.Google Scholar
13.American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.Google Scholar
14.Strauss, E, Sherman, EMS, Spreen, O.Norms election in neuropsychological assessment. A Compendium of Neuropsychological Tests. 3rd ed. Oxford, UK: Oxford University Press; 2002. p. 49.Google Scholar
15.Rabin, LA, Saykin, AJ, Wishart, HA, et al.The memory and aging telephone screen: development and preliminary validation. Alzheimers Dement. 2007;3(2):109–21.Google Scholar
16.Morris, JC.Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. Int Psychogeriatr. 1997;9 Suppl 1:173–6.Google Scholar
17.Massoud, F, Devi, G, Stern, Y, et al.A clinicopathological comparison of community-based and clinic-based cohorts of patients with dementia. Arch neurol. 1999;56(11):1368–73.Google Scholar
18.Stern, Y.What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002;8(3):448–60.Google Scholar
19.Jones, RN, Manly, J, Glymour, MM, Rentz, DM, Jefferson, AL, Stern, Y.Conceptual and measurement challenges in research on cognitive reserve. J Int Neuropsychol Soc. 2011;17(4):593–601.Google Scholar
20.Valenzuela, MJ, Sachdev, P.Brain reserve and dementia: a systematic review. Psychol Med. 2006;36(4):441–54.Google Scholar
21.Valenzuela, MJ, Sachdev, P.Brain reserve and cognitive decline: a non-parametric systematic review. Psychol Med. 2006;36(8):1065–73.Google Scholar
22.Rossetti, HC, Lacritz, LH, Cullum, CM, Weiner, MF.Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample. Neurology. 2011;77(13):1272–5.Google Scholar
23.Luis, CA, Keegan, AP, Mullan, M.Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry. 2009;24(2):197–201.CrossRefGoogle ScholarPubMed
24.Nasreddine, ZS, Phillips, N, Chertkow, H.Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample. Neurology. 2012;78(10):765–6.Google Scholar