reported better longitudinal sensitivity for MoCA than MMSE. Greater sensitivity to detect mild levels of cognitive impairment has been reported for the MoCA in MCI and AD dementia, stroke and transient ischemic attack patients and Parkinson’s disease.
Though it offers many of the same advantages of the MMSE, the MoCA was developed as a more challenging test that includes executive function, higher-level language, and complex visuospatial processing to enable detection of mild impairment with less ceiling effect. As research increasingly focuses on milder stages of AD, options other than the MMSE are needed for clinicians for earlier diagnosis and management. Its poor sensitivity for distinguishing mild cognitive impairment (MCI) is well-described and can be attributed to a lack of complexity as well as the absence of executive function items. One problem with the MMSE is its ceiling effect or limited dynamic performance range for normal individuals, which increases the likelihood that persons in predementia stages score within the normal range (24 and above). The MMSE is also commonly used as a proxy for staging of Alzheimer’s disease (AD). Though there are a number of possible tests, they recommend the Mini-Mental State Examination (MMSE), the most widely used cognitive screening test used by physicians for general cognitive evaluation, and also the newer Montreal Cognitive Assessment (MoCA). Galvin and Sadowski recently wrote clinical recommendations for primary care physician evaluation of older patients for cognitive impairment, emphasizing the need to look for early warning signs where formal cognitive testing can aid detection. Office-based, multi-domain cognitive tests are commonly administered in clinical situations to evaluate patients with cognitive impairment. MoCA scores are translatable to the MMSE to facilitate comparison. Functional assessment can help exclude dementia cases. 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. MoCA and MMSE were more similar for dementia cases, but MoCA distributes MCI cases across a broader score range with less ceiling effect. Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC. The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful. ROC analysis found MoCA ≥ 17 as the cutoff between MCI and dementia that emphasized high sensitivity (92.3 %) to capture MCI cases. Equi-percentile equating showed a MoCA score of 18 was equivalent to MMSE of 24. MoCA and MMSE scores correlated most for dementia ( r = 0.86 versus MCI r = 0.60 HC r = 0.43). The ceiling effect (28–30 points) for MCI and HC was less using MoCA (18.1 %) versus MMSE (71.4 %). Most dementia cases scored abnormally, while MCI and HC score distributions overlapped on each test. Receiver Operating Characteristic (ROC) analyses evaluated lower cutoff scores for capturing the most MCI cases. Equi-percentile equating produced a translation grid for MoCA against MMSE scores.
Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI. Stepwise variable selection in logistic regression evaluated relative value of four test domains for separating MCI from HC. Methodsįor 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. Clinicians need to better understand the relationship between MoCA and MMSE scores. 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).
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