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Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults.

Trzepacz PT, Hochstetler H, Wang S, Walker B, Saykin AJ, Alzheimer’s Disease Neuroimaging Initiati - BMC Geriatr (2015)

Bottom Line: Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI.The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful.Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC.

View Article: PubMed Central - PubMed

Affiliation: Indiana University School of Medicine, Indianapolis, IN, USA. pttrzepacz@outlook.com.

ABSTRACT

Background: The Montreal Cognitive Assessment (MoCA) was developed to enable earlier detection of mild cognitive impairment (MCI) relative to familiar multi-domain tests like the Mini-Mental State Exam (MMSE). Clinicians need to better understand the relationship between MoCA and MMSE scores.

Methods: For this cross-sectional study, we analyzed 219 healthy control (HC), 299 MCI, and 100 Alzheimer's disease (AD) dementia cases from the Alzheimer's Disease Neuroimaging Initiative (ADNI)-GO/2 database to evaluate MMSE and MoCA score distributions and select MoCA values to capture early and late MCI cases. Stepwise variable selection in logistic regression evaluated relative value of four test domains for separating MCI from HC. Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI. Equi-percentile equating produced a translation grid for MoCA against MMSE scores. Receiver Operating Characteristic (ROC) analyses evaluated lower cutoff scores for capturing the most MCI cases.

Results: Most dementia cases scored abnormally, while MCI and HC score distributions overlapped on each test. Most MCI cases scored ≥ 17 on MoCA (96.3%) and ≥ 24 on MMSE (98.3%). The ceiling effect (28-30 points) for MCI and HC was less using MoCA (18.1%) versus MMSE (71.4%). MoCA and MMSE scores correlated most for dementia (r = 0.86; versus MCI r = 0.60; HC r = 0.43). Equi-percentile equating showed a MoCA score of 18 was equivalent to MMSE of 24. ROC analysis found MoCA ≥ 17 as the cutoff between MCI and dementia that emphasized high sensitivity (92.3%) to capture MCI cases. The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful. Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC.

Conclusions: MoCA and MMSE were more similar for dementia cases, but MoCA distributes MCI cases across a broader score range with less ceiling effect. A cutoff of ≥ 17 on the MoCA may help capture early and late MCI cases; depending on the level of sensitivity desired, ≥ 18 or 19 could be used. Functional assessment can help exclude dementia cases. MoCA scores are translatable to the MMSE to facilitate comparison.

No MeSH data available.


Related in: MedlinePlus

ROC analysis graph of MoCA scores for distinguishing MCI subjects (n = 299) from the AD dementia group (n = 100) and table for MoCA values to consider as lower cutoff values for MCI (17–20) depending on sensitivity and specificity levels preferred in a given situation
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Fig3: ROC analysis graph of MoCA scores for distinguishing MCI subjects (n = 299) from the AD dementia group (n = 100) and table for MoCA values to consider as lower cutoff values for MCI (17–20) depending on sensitivity and specificity levels preferred in a given situation

Mentions: ROC analysis of MoCA scores performed for MCI, as differentiated from AD dementia, had an AUC of 0.9033 (see Fig. 3). A MoCA cutoff score of 17 emphasized sensitivity (92.3 %) with specificity of 58 %, while a cutoff of 19 had somewhat lower sensitivity (87.3 %) and higher specificity (77 %). The Youden index was highest (69.9) for a MoCA cutoff of 20 with the balance of sensitivity (81.9 %) and specificity (88.0 %).Fig. 3


Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults.

Trzepacz PT, Hochstetler H, Wang S, Walker B, Saykin AJ, Alzheimer’s Disease Neuroimaging Initiati - BMC Geriatr (2015)

ROC analysis graph of MoCA scores for distinguishing MCI subjects (n = 299) from the AD dementia group (n = 100) and table for MoCA values to consider as lower cutoff values for MCI (17–20) depending on sensitivity and specificity levels preferred in a given situation
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4562190&req=5

Fig3: ROC analysis graph of MoCA scores for distinguishing MCI subjects (n = 299) from the AD dementia group (n = 100) and table for MoCA values to consider as lower cutoff values for MCI (17–20) depending on sensitivity and specificity levels preferred in a given situation
Mentions: ROC analysis of MoCA scores performed for MCI, as differentiated from AD dementia, had an AUC of 0.9033 (see Fig. 3). A MoCA cutoff score of 17 emphasized sensitivity (92.3 %) with specificity of 58 %, while a cutoff of 19 had somewhat lower sensitivity (87.3 %) and higher specificity (77 %). The Youden index was highest (69.9) for a MoCA cutoff of 20 with the balance of sensitivity (81.9 %) and specificity (88.0 %).Fig. 3

Bottom Line: Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI.The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful.Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC.

View Article: PubMed Central - PubMed

Affiliation: Indiana University School of Medicine, Indianapolis, IN, USA. pttrzepacz@outlook.com.

ABSTRACT

Background: The Montreal Cognitive Assessment (MoCA) was developed to enable earlier detection of mild cognitive impairment (MCI) relative to familiar multi-domain tests like the Mini-Mental State Exam (MMSE). Clinicians need to better understand the relationship between MoCA and MMSE scores.

Methods: For this cross-sectional study, we analyzed 219 healthy control (HC), 299 MCI, and 100 Alzheimer's disease (AD) dementia cases from the Alzheimer's Disease Neuroimaging Initiative (ADNI)-GO/2 database to evaluate MMSE and MoCA score distributions and select MoCA values to capture early and late MCI cases. Stepwise variable selection in logistic regression evaluated relative value of four test domains for separating MCI from HC. Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI. Equi-percentile equating produced a translation grid for MoCA against MMSE scores. Receiver Operating Characteristic (ROC) analyses evaluated lower cutoff scores for capturing the most MCI cases.

Results: Most dementia cases scored abnormally, while MCI and HC score distributions overlapped on each test. Most MCI cases scored ≥ 17 on MoCA (96.3%) and ≥ 24 on MMSE (98.3%). The ceiling effect (28-30 points) for MCI and HC was less using MoCA (18.1%) versus MMSE (71.4%). MoCA and MMSE scores correlated most for dementia (r = 0.86; versus MCI r = 0.60; HC r = 0.43). Equi-percentile equating showed a MoCA score of 18 was equivalent to MMSE of 24. ROC analysis found MoCA ≥ 17 as the cutoff between MCI and dementia that emphasized high sensitivity (92.3%) to capture MCI cases. The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful. Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC.

Conclusions: MoCA and MMSE were more similar for dementia cases, but MoCA distributes MCI cases across a broader score range with less ceiling effect. A cutoff of ≥ 17 on the MoCA may help capture early and late MCI cases; depending on the level of sensitivity desired, ≥ 18 or 19 could be used. Functional assessment can help exclude dementia cases. MoCA scores are translatable to the MMSE to facilitate comparison.

No MeSH data available.


Related in: MedlinePlus