Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease

Departments of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
Neurology (Impact Factor: 8.29). 11/2009; 73(21):1738-45. DOI: 10.1212/WNL.0b013e3181c34b47
Source: PubMed


Due to the high prevalence of mild cognitive impairment (MCI) and dementia in Parkinson disease (PD), routine cognitive screening is important for the optimal management of patients with PD. The Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting MCI and dementia in patients without PD, but its validity in PD has not been established.
A representative sample of 132 patients with PD at 2 movement disorders centers was administered the MoCA, MMSE, and a neuropsychological battery with operationalized criteria for deficits. MCI and PD dementia (PDD) criteria were applied by an investigator blinded to the MoCA and MMSE results. The discriminant validity of the MoCA and MMSE as screening and diagnostic instruments was ascertained.
Approximately one third of the sample met diagnostic criteria for a cognitive disorder (12.9% PDD and 17.4% MCI). Mean (SD) MoCA and MMSE scores were 25.0 (3.8) and 28.1 (2.0). The overall discriminant validity for detection of any cognitive disorder was similar for the MoCA and the MMSE (receiver operating characteristic area under the curve [95% confidence interval]): MoCA (0.79 [0.72, 0.87]) and MMSE (0.76 [0.67, 0.85]), but as a screening instrument the MoCA (optimal cutoff point = 26/27, 64% correctly diagnosed, lack of ceiling effect) was superior to the MMSE (optimal cutoff point = 29/30, 54% correctly diagnosed, presence of ceiling effect).
The Montreal Cognitive Assessment, but not the Mini-Mental State Examination, has adequate psychometric properties as a screening instrument for the detection of mild cognitive impairment or dementia in Parkinson disease. However, a positive screen using either instrument requires additional assessment due to suboptimal specificity at the recommended screening cutoff point.

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Available from: Sarra Nazem, Oct 10, 2015
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    • "MoCA to detect cognitive impairment in Parkinson's disease (Hoops et al., 2009), cardiovascular disease and stroke (McLennan, Mathias, Brennan, & Stewart, 2011; Pendlebury, Cuthbertson, Welch, Mehta, & Rothwell, 2010), REM sleep behavior disorder (Gagnon, Postuma, Joncas, Desjardins, & Latreille, 2010), and brain metastases (Olson, Chhanabhai, & McKenzie, 2008). A recent meta-analysis of practice effects on a range of cognitive tests concluded that practice effects are apparent, particularly in the domains of visual memory, attention, working memory, executive functioning, and processing speed, and that greater practice effects are observed for shorter test–retest intervals and tests without alternate forms (Calamia, Markon, & Tranel, 2012). "
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    ABSTRACT: Objective: The Montreal Cognitive Assessment (MoCA) is a brief screening measure commonly used to determine cognitive status among older adults. Despite the popularity of the MoCA, there has been little research into how performance on the MoCA changes over time in healthy older adults. Methods: The present study examined a sample of older adults (n = 53) recruited for a longitudinal study of healthy aging. Change in total MoCA score at three time points (baseline, 12 months, and 48 months) and scores from the Repeatable Battery for the Assessment of Neuropsychological Status at five time points (RBANS; baseline 12 months, 24 months, 36 months, and 48 months) were assessed using repeated measures analyses. Results: Total MoCA score significantly increased across time, particularly between the first and second administrations. Scores did not significantly differ between the second (12 month) and third (48 month) administrations. When grouped by baseline performance, individuals who scored low at baseline significantly improved performance at 12-month testing, but had little change between 12- and 48-month testing. Conversely, individuals who scored high at baseline did not significantly change between baseline and 12-month testing, but improved between 12- and 48-month testing. RBANS scores did not significantly change over time. Conclusions: These results suggest that the MoCA may be susceptible to practice effects, particularly between the first and second administrations. These practice effects should be taken into consideration when repeatedly employing the MoCA to screen for cognitive status in healthy older adults.
    The Clinical Neuropsychologist 09/2015; DOI:10.1080/13854046.2015.1087596 · 1.72 Impact Factor
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    • "Comparing to MMSE, MoCA is a more sensitive tool for testing executive, visuospatial functions and attention, which areas are most often impaired in PD. MoCA also has high interrater, testretest reliability [35], and good discriminant validity for assessing dementia in PD [36] [37]. Further studies demonstrate that MoCA is able to assess broader cognitive domains, and it has higher sensitivity for detecting mild cognitive impairment and dementia in PD [38] [39]. "
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    ABSTRACT: Introduction: Among the nonmotor features of Parkinson's disease (PD), cognitive impairment is one of the most troublesome problems. New diagnostic criteria for mild and major neurocognitive disorder (NCD) in PD were established by Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5). The aim of our study was to establish the diagnostic accuracy of widely used screening tests for NCD in PD. Methods: Within the scope of our study we evaluated the sensitivity and specificity of different neuropsychological tests (Addenbrooke's Cognitive Examination (ACE), Mattis Dementia Rating Scale (MDRS), Mini Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA)) in 370 PD patients without depression. Results: MoCA and ACE feature the finest diagnostic accuracy for detecting mild cognitive disorder in PD (DSM-5) at the cut-off scores of 23.5 and 83.5 points, respectively. The diagnostic accuracy of these tests was 0.859 (95% CI: 0.818-0.894, MoCA) and 0.820 (95% CI: 0.774-0.859, ACE). In the detection of major NCD (DSM-5), MoCA and MDRS tests exhibited the best diagnostic accuracy at the cut-off scores of 20.5 and 132.5 points, respectively. The diagnostic accuracy of these tests was 0.863 (95% CI: 0.823-0.897, MoCA) and 0.830 (95% CI: 0.785-0.869, MDRS). Conclusion: Our study demonstrated that the MoCA may be the most suitable test for detecting mild and major NCD in PD.
    Behavioural neurology 06/2015; 2015:1-10. DOI:10.1155/2015/983606 · 1.45 Impact Factor
    • "Below this, scores can indicate severe (≤9 points), moderate (10-20 points) or mild (21-24 points) cognitive impairment. MMSE scores are indicative of cognitive impairment in general and thus useful for most types of dementia as well, with the exception of PDD (Hoops et al. 2009). "
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    ABSTRACT: Older drivers with dementia are an at-risk group for unsafe driving. However, dementia refers to various aetiologies and the question is whether dementias of different aetiology have similar effects on driving ability. The literature on the effects of dementia of various aetiologies on driving ability is reviewed. Studies addressing dementia aetiologies and driving were identified through PubMed, PsychINFO and Google Scholar. Early symptoms and prognoses differ between dementias of different aetiology. Therefore, different aetiologies may represent different likelihoods with regard to fitness to drive. Moreover, dementia aetiologies could indicate the type of driving problems that can be expected to occur. However, there is a great lack of data and knowledge about the effects of almost all aetiologies of dementia on driving. One could hypothesize that patients with Alzheimer's disease may well suffer from strategic difficulties such as finding a route while patients with frontotemporal dementia are more inclined to make tactical level errors because of impaired hazard perception. Patients with other dementia aetiologies involving motor symptoms may suffer from problems on the operational level. Still, the effects of various aetiologies of dementias on driving have thus far not been studied thoroughly. For the detection of driving difficulties in patients with dementia, structured interviews with patients but also their family members appear crucial. Neuropsychological assessment could support the identification of cognitive impairments. The impact of such impairments on driving could also be investigated in a driving simulator. In a driving simulator, strengths and weaknesses in driving behaviour can be observed. With this knowledge, patients can be advised appropriately about their fitness to drive and options for support in driving (e.g. compensation techniques, car adaptations). However, as long as no valid, reliable, and widely accepted test battery is available for the assessment of fitness to drive, costly on-road test rides are inevitable. The development of a fitness-to-drive test battery for patients with dementia could provide an alternative for these on-road test rides, on condition that differences between dementia aetiologies are taken into consideration.
    Traffic Injury Prevention 04/2015; DOI:10.1080/15389588.2015.1038786 · 1.41 Impact Factor
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