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Screening utility of the Montreal Cognitive Assessment (MoCA): in place of – or as well as – the MMSE?

Published online by Cambridge University Press:  03 October 2011

A. J. Larner*
Affiliation:
Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
*
Correspondence should be addressed to: A.J. Larner, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool, UK. Phone: +44 151 529 5727; Fax: +44 151 529 8552. Email: a.larner@thewaltoncentre.nhs.uk.

Abstract

Background: This aim of this study was to assess the clinical utility of the Montreal Cognitive Assessment (MoCA) as a screening instrument for cognitive impairment in patients referred to a memory clinic, alone and in combination with the Mini-Mental State Examination (MMSE).

Methods: This was a pragmatic prospective study of consecutive referrals attending a memory clinic (n = 150) over an 18-month period. Patients were diagnosed using standard clinical diagnostic criteria for dementia (DSM-IV) and mild cognitive impairment (MCI; cognitive impairment prevalence = 43%) independent of MoCA test scores.

Results: MoCA proved acceptable to patients and was quick and easy to use. Using the cut-offs for MoCA and MMSE specified in the index paper (≥26/30), MoCA was more sensitive than MMSE (0.97 vs 0.65) but less specific (0.60 vs 0.89), with better diagnostic accuracy (area under Receiver Operating Characteristic curve 0.91 vs 0.83). Downward adjustment of the MoCA cut-off to ≥20/30 maximized test accuracy and improved specificity (0.95) for some loss of sensitivity (0.63). Combining MoCA with the MMSE – either in series or in parallel – did not improve diagnostic utility above that with either test alone.

Conclusions: In a memory clinic population, MoCA proved sensitive for the diagnosis of cognitive impairment. Use of a cut-off lower than that specified in the index study may be required to improve overall test accuracy and specificity for some loss of sensitivity in populations with a high prior probability of cognitive impairment. Combining the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) with the MMSE did not improve diagnostic utility.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2011

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References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revison (DSM-IV-TR). Washington, DC: American Psychiatric Association.Google ScholarPubMed
Bossuyt, P. M. et al. (2003). The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Clinical Chemistry, 49, 718.CrossRefGoogle ScholarPubMed
Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 3746.CrossRefGoogle Scholar
Damian, A. M. et al. (2011). The Montreal Cognitive Assessment and the Mini-Mental State Examination as screening instruments for cognitive impairment: item analyses and threshold scores. Dementia and Geriatric Cognitive Disorders, 31, 126131.CrossRefGoogle ScholarPubMed
Dong, Y. et al. (2010). The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. Journal of the Neurological Sciences, 299, 1518.CrossRefGoogle ScholarPubMed
Flicker, L., Logiudice, D., Carlin, J. B. and Ames, D. (1997). The predictive value of dementia screening instruments in clinical populations. International Journal of Geriatric Psychiatry, 12, 203209.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Gagnon, J. F., Postuma, R. B., Joncas, S., Desjardins, C. and Latreille, V. (2010). The Montreal Cognitive Assessment: a screening tool for mild cognitive impairment in REM sleep behaviour disorder. Movement Disorders, 25, 936940.CrossRefGoogle Scholar
Gifford, D. R. and Cummings, J. L. (1999). Evaluating dementia screening tests: methodologic standards to rate their performance. Neurology, 52, 224227.CrossRefGoogle ScholarPubMed
Gill, D. J., Freshman, A., Blender, J. A. and Ravina, B. (2008). The Montreal Cognitive Assessment as a screening tool for cognitive impairment in Parkinson's disease. Movement Disorders, 23, 10431046.CrossRefGoogle ScholarPubMed
Hancock, P. and Larner, A. J. (2009). Diagnostic utility of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and its combination with the Addenbrooke's Cognitive Examination-Revised (ACE-R) in a memory clinic-based population. International Psychogeriatrics, 21, 526530.CrossRefGoogle Scholar
Hancock, P. and Larner, A. J. (2011). Test Your Memory (TYM) test: diagnostic utility in a memory clinic population. International Journal of Geriatric Psychiatry, 26, 976980.CrossRefGoogle Scholar
Larner, A. J. (2007). Addenbrooke's Cognitive Examination (ACE) for the diagnosis and differential diagnosis of dementia. Clinical Neurology and Neurosurgery, 109, 491494.CrossRefGoogle ScholarPubMed
Larner, A. J. (2009). ACE-R: cross-sectional and longitudinal use for cognitive assessment. In Fisher, A. and Hanin, I. (eds.), New Trends in Alzheimer and Parkinson Related Disorders: ADPD 2009. Collection of selected free papers from the 9th International Conference on Alzheimer's and Parkinson's disease AD/PD. Prague, Czech Republic, 11–15 March (pp.103–107) Bologna: Medimond International Proceedings.Google Scholar
Larner, A. J. (in press). Mini-Mental Parkinson (MMP) as a dementia screening test: comparison with the Mini-Mental State Examination (MMSE). Current Aging Science, 4.Google Scholar
Luis, C. A., Keegan, A. P. and Mullan, M. (2009). Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. International Journal of Geriatric Psychiatry, 24, 197201.CrossRefGoogle ScholarPubMed
Mitchell, A. J., McGlinchey, J. B., Young, D., Chelminski, I. and Zimmerman, M. (2009). Accuracy of specific symptoms in the diagnosis of major depressive disorder in psychiatric out-patients: data from the MIDAS project. Psychological Medicine, 39, 11071116.CrossRefGoogle Scholar
Nasreddine, Z. S. et al. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695699.CrossRefGoogle ScholarPubMed
Nazem, S. et al. (2009). Montreal Cognitive Assessment performance in patients with Parkinson's disease with “normal” global cognition according to Mini-Mental State Examination score. Journal of the American Geriatrics Society, 57, 304308.CrossRefGoogle ScholarPubMed
Olson, R. A., Chhanabhai, T. and McKenzie, M. (2008). Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases. Supportive Care in Cancer, 16, 12731278.CrossRefGoogle ScholarPubMed
Pendlebury, S. T., Cuthbertson, F. C., Welch, S. J., Mehta, Z. and Rothwell, P. M. (2010). Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: a population-based study. Stroke, 41, 12901293.CrossRefGoogle ScholarPubMed
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303308.CrossRefGoogle ScholarPubMed
Smith, T., Gildeh, N. and Holmes, C. (2007). The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Canadian Journal of Psychiatry, 52, 329332.CrossRefGoogle Scholar
Videnovic, A., Bernard, B., Fan, W., Jaglin, J., Leurgans, S. and Shannon, K. M. (2010). The Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in Huntington's disease. Movement Disorders, 25, 401404.CrossRefGoogle ScholarPubMed
Wong, A. et al. (2009). The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dementia and Geriatric Cognitive Disorders, 28, 8187.CrossRefGoogle Scholar
Zadikoff, C. et al. (2008). A comparison of the mini mental state exam to the Montreal Cognitive Assessment in identifying cognitive deficits in Parkinson's disease. Movement Disorders, 23, 297299.CrossRefGoogle ScholarPubMed
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Screening utility of the Montreal Cognitive Assessment (MoCA): in place of – or as well as – the MMSE?
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