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The Montreal Cognitive Assessment is superior to the Mini–Mental State Examination in detecting patients at higher risk of dementia

Published online by Cambridge University Press:  12 June 2012

YanHong Dong ,
Wah Yean Lee ,
Nur Adilah Basri ,
Simon Lowes Collinson ,
Reshma A. Merchant ,
Narayanaswamy Venketasubramanian  and
Christopher Li-Hsian Chen
YanHong Dong
Affiliation:
Department of Pharmacology, National University Health System, Clinical Research Centre, Singapore School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
Wah Yean Lee
Affiliation:
Department of Pharmacology, National University Health System, Clinical Research Centre, Singapore
Nur Adilah Basri
Affiliation:
Department of Pharmacology, National University Health System, Clinical Research Centre, Singapore
Simon Lowes Collinson
Affiliation:
Department of Psychology, National University of Singapore, Singapore
Reshma A. Merchant
Affiliation:
Department of Medicine, National University Health System, Singapore
Narayanaswamy Venketasubramanian
Affiliation:
Department of Medicine, National University Health System, Singapore
Christopher Li-Hsian Chen*
Affiliation:
Department of Pharmacology, National University Health System, Clinical Research Centre, Singapore
*
Correspondence should be addressed to: Dr Christopher Li-Hsian Chen, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Clinical Research Centre, MD11, Level 5, #05-9, 10 Medical Drive, Singapore 117597, Singapore. Phone: +65 65165885; Fax: +65 68724101. Email: phccclh@nus.edu.sg.
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Abstract

Background: To examine the discriminant validity of the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) in detecting patients with cognitive impairment at higher risk for dementia at a memory clinic setting.

Methods: Memory clinic patients were administered the MoCA, MMSE, and a comprehensive formal neuropsychological battery. Mild cognitive impairment (MCI) subtypes were dichotomized into two groups: single domain–MCI (sd–MCI) and multiple domain-MCI (md–MCI). Area under the receiver operating characteristic curve (ROC) analysis was used to compare the discriminatory ability of the MoCA and the MMSE.

Results: Two hundred thirty patients were recruited, of which 136 (59.1%) were diagnosed with dementia, 61 (26.5%) with MCI, and 33 (14.3%) with no cognitive impairment (NCI). The majority of MCI patients had md–MCI (n = 36, 59%). The MoCA had significantly larger AUCs than the MMSE in discriminating md–MCI from the lower risk group for incident dementia (NCI and sd–MCI) [MoCA 0.92 (95% CI, 0.86–0.98) vs. MMSE 0.84 (95% CI, 0.75–0.92), p = 0.02). At their optimal cut-off points, the MoCA (19/20) remained superior to the MMSE (23/24) in detecting md–MCI [sensitivity: 0.83 vs. 0.72; specificity: 0.86 vs. 0.83; PPV: 0.79 vs. 0.72; NPV: 0.89 vs. 0.83; correctly classified: 85.1% vs. 78.7%].

Conclusion: The MoCA is superior to the MMSE in the detection of patients with cognitive impairment at higher risk for incident dementia at a memory clinic setting.

Keywords

mild cognitive impairmentmemory clinicsscreening
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 11 , November 2012 , pp. 1749 - 1755
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Bossuyt, P. M. et al. (2003). Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ, 326, 41–44.Google Scholar
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, 15–18.Google Scholar
Dubois, B. and Litvan, I. (2000). The FAB: a frontal assessment battery at bedside. Neurology, 55, 1621–1626.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, 189–198.CrossRefGoogle Scholar
Forlenza, O. V., Diniz, B. S., Nunes, P. V., Memória, C. M., Yassuda, M. S. and Gattaz, W. F. (2009). Diagnostic transitions in mild cognitive impairment subtypes. International Psychogeriatrics, 21, 1088–1095.CrossRefGoogle ScholarPubMed
Fujiwara, Y. et al. (2010). Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment. Geriatrics & Gerontology International, 10, 225–232.Google Scholar
Ganguli, M. et al. (2011). Outcomes of mild cognitive impairment by definition: a population study. Archives of Neurology, 68, 761–767.CrossRefGoogle ScholarPubMed
Godefroy, O. et al. (2011). Is the Montreal Cognitive Assessment superior to the Mini-Mental State Examination to detect poststroke cognitive impairment? A study with neuropsychological evaluation. Stroke, 42, 1712–1716.CrossRefGoogle Scholar
Graham, J. E. et al. (1997). Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet, 349, 1793–1796.CrossRefGoogle Scholar
Hanley, J. A. and McNeil, B. J. (1983). A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology, 148, 839–843.Google Scholar
Hoops, S. et al. (2009). Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology, 73, 1738–1745.CrossRefGoogle ScholarPubMed
Larner, A. J. (2011). Screening utility of the Montreal Cognitive Assessment (MoCA): in place of – or as well as – the MMSE? International Psychogeriatrics, 24, 391–396.Google Scholar
Lee, J. Y. et al. (2008). Brief screening for mild cognitive impairment in elderly outpatient clinic: validation of the Korean version of the Montreal Cognitive Assessment. Journal of Geriatric Psychiatry and Neurology, 21, 104–110.CrossRefGoogle ScholarPubMed
McLennan, S. N., Mathias, J. L., Brennan, L. C. and Stewart, S. (2010). Validity of the Montreal Cognitive Assessment (MoCA) as a screening test for mild cognitive impairment (MCI) in a cardiovascular population. Journal of Geriatric Psychiatry and Neurology, 24, 33–38.Google 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, 695–699.CrossRefGoogle Scholar
Pendlebury, S. T., Cuthbertson, F. C., Welch, S. J. V., 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, 1290–1293.CrossRefGoogle ScholarPubMed
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183–194.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, 303–308.Google Scholar
Rasquin, S. M. C., Lodder, J., Visser, P. J., Lousberg, R. and Verhey, F. R. J. (2005). Predictive accuracy of MCI subtypes for Alzheimer’s disease and vascular dementia in subjects with mild cognitive impairment: a 2-year follow-up study. Dementia and Geriatric Cognitive Disorders, 19, 113–119.CrossRefGoogle Scholar
Sheikh, J. J. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. Clinical Gerontolologist: The Journal of Aging and Mental Health, 5, 165–173.Google Scholar
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, 329–332.CrossRefGoogle Scholar
The American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: The American Psychiatric Association.Google Scholar
Yeo, D., Gabriel, C., Chen, C., Lee, S., Loenneker, T. and Wong, M. (1997). Pilot validation of a customized neuropsychological battery in elderly Singaporeans Neurological Journal of South East Asia, 2, 123.Google Scholar