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: 8.3). 11/2009; 73(21):1738-45. DOI: 10.1212/WNL.0b013e3181c34b47
Source: PubMed

ABSTRACT 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, Aug 30, 2015
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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 01/2015; 2015:1-10. DOI:10.1155/2015/983606 · 1.64 Impact Factor
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    • "Secured written informed consent from participant and/or carer Verified and updated information previously abstracted from their clinical records Assessed cognition using the Montreal Cognitive Assessment (MoCA [23]), shown to allow better examination of the frontal cognitive domains than MMSE [24] Took a detailed history of falls over the previous 12 months [25] Video-recorded the Standing-Start 180 Turn Test (SS-180 [26]); we instructed participants to stand facing away from the camera and, when ready, walk towards it. After initially turning in an unspecified direction, the participants repeated the task turning the opposite way. "
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    ABSTRACT: We compared fall frequency and prediction among People with Parkinson's Disease (PwP) with and without cognitive impairment (CI); researchers sometimes overlook the former, concerned about consent, recall and adherence and differences in fall frequency and predictability.Methods We recruited 101 PwP from one clinic, used the Montreal Cognitive Assessment to measure CI, noted repeated falls recalled retrospectively over 12 months and evaluated ‘repeated falls’ and ‘difficulty turning’ as predictors of falls over three months.ResultsParticipant median age was 76 years, and time since diagnosis 6 years. Of 40 participants without CI, 40% recalled falls and 55% fell during follow-up (1.9 (±3.8) falls/person), the sensitivity of fall history being 57% and of turning 36%. Of 36 participants with mild CI, 42% recalled falls and 42% fell during follow-up (1.2 (±1.8) falls/person), the sensitivity of fall history being 67% and of turning 69%. Of 25 participants with moderate CI, 60% recalled falls and 58% fell during follow-up (1.2 (±1.8) falls/person), the sensitivity of fall history being 71% and of turning 69%.Conclusions Researchers need not exclude people with CI assuming falls are more frequent and less predictable than among those without. Fall rates (falls/person during follow-up) were similar among people with and without CI. Falls and difficulty turning were more sensitive predictors of falling in those with CI than those without: a simple mobility test may suggest an individual's risk of falling if a history is unavailable. Most PwP with moderate CI fall repeatedly: carer involvement facilitates their inclusion in research.
    Parkinsonism & Related Disorders 11/2014; 21(1). DOI:10.1016/j.parkreldis.2014.11.001 · 4.13 Impact Factor
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    • "The Montreal Cognitive Assessment (MoCA), a recently developed brief cognitive screening instrument, has been used in different clinical settings because of its high sensitivity and specificity for detecting cognitive impairments (Nasreddine et al., 2005; Popović et al., 2007; Copersino et al., 2009; Luis et al., 2009). With a test–retest reliability of .92 and validity to MMSE of .87, a considerable body of research shows that the MoCA seems to be superior to the Mini-Mental State Examination (MMSE), which is one of the gold-standard cognitive assessments in dementia, in detecting mild cognitive impairment (Popović et al., 2007; Hoops et al., 2009; Pendlebury et al., 2010). The main difference between the MoCA and MMSE is that the MoCA also includes tasks assessing executive function and abstraction. "
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    ABSTRACT: Cognitive impairment has been suggested to be a core feature of a schizophrenia diagnosis. Many comprehensive neuropsychological batteries and experimental procedures have been used to assess cognitive impairment in schizophrenia. A few brief performance-based cognitive assessments have been developed to fulfill the need of a more feasible cognitive assessment for schizophrenia in clinical settings. However, their usability is in question. The Montreal Cognitive Assessment (MoCA), a brief cognitive assessment tool, has been used widely in different clinical settings because of its high sensitivity and specificity for detecting cognitive impairments. This study assessed cognitive function in patients with schizophrenia by using the MoCA tool. The results showed that the MoCA was sensitive enough to detect cognitive impairment in patients with schizophrenia. It also provided normative data for the MoCA in schizophrenia patients. Furthermore, the results revealed that cognitive impairment measured by the MoCA was correlated with their education level, severity of illness, and negative symptoms. Lastly, the MoCA total score could be a significant predictor of patients' length of stay in the facility.
    Schizophrenia Research 08/2014; 158(1-3). DOI:10.1016/j.schres.2014.07.006 · 4.43 Impact Factor
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