Original Research Article
The Montreal Cognitive Assessment and the Mini-Mental State Examination as Screening Instruments for Cognitive Impairment: Item Analyses and Threshold ScoresDamian A.M.a · Jacobson S.A.b · Hentz J.G.c · Belden C.M.b · Shill H.A.b · Sabbagh M.N.b · Caviness J.N.c · Adler C.H.c
aUniversity of Arizona College of Medicine Phoenix Campus, Phoenix, Ariz., bBanner Sun Health Research Institute, Sun City, Ariz., and cMayo Clinic, Scottsdale, Ariz., USA
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Aims: To perform an item analysis of the Montreal Cognitive Assessment (MoCA) versus the Mini-Mental State Examination (MMSE) in the prediction of cognitive impairment, and to examine the characteristics of different MoCA threshold scores. Methods: 135 subjects enrolled in a longitudinal clinicopathologic study were administered the MoCA by a single physician and the MMSE by a trained research assistant. Subjects were classified as cognitively impaired or cognitively normal based on independent neuropsychological testing. Results: 89 subjects were found to be cognitively normal, and 46 cognitively impaired (20 with dementia, 26 with mild cognitive impairment). The MoCA was superior in both sensitivity and specificity to the MMSE, although not all MoCA tasks were of equal predictive value. A MoCA threshold score of 26 had a sensitivity of 98% and a specificity of 52% in this population. In a population with a 20% prevalence of cognitive impairment, a threshold of 24 was optimal (negative predictive value 96%, positive predictive value 47%). Conclusion: This analysis suggests the potential for creating an abbreviated MoCA. For screening in primary care, the MoCA threshold of 26 appears optimal. For testing in a memory disorders clinic, a lower threshold has better predictive value.
© 2011 S. Karger AG, Basel
- Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
- Pendlebury ST, Cuthbertson FC, Welch SJ, Mehta Z, Rothwell PM: 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 2010;41:1290–1293.
- Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A: The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry 2000;15:1021–1027.
- Mathuranath PS, Nestor PJ, Berrios GE, Rakowicz W, Hodges JR: A brief cognitive test battery to differentiate Alzheimer’s disease and frontotemporal dementia. Neurology 2000;55:1613–1620.
- Buschke H, Kuslansky G, Katz M, Stewart WF, Sliwinski MJ, Eckholdt HM, Lipton RB: Screening for dementia with the memory impairment screen. Neurology 1999;52:231–238.
- Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H: The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695–699.
- Smith T, Gildeh N, Holmes C: The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Can J Psychiatry 2007;52:329–332.
- Gill DJ, Freshman A, Blender JA, Ravina B: The Montreal cognitive assessment as a screening tool for cognitive impairment in Parkinson’s disease. Mov Disord 2008;23:1043–1046.
- Zadikoff C, Fox SH, Tang-Wai DF, Thomsen T, de Bie RM, Wadia P, Miyasaki J, Duff-Canning S, Lang AE, Marras C: A comparison of the Mini Mental State Exam to the Montreal cognitive assessment in identifying cognitive deficits in Parkinson’s disease. Mov Disord 2008;23:297–299.
- Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB, Weintraub D: Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology 2009;73:1738–1745.
- Nazem S, Siderowf AD, Duda JE, Have TT, Colcher A, Horn SS, Moberg PJ, Wilkinson JR, Hurtig HI, Stern MB, Weintraub D: Montreal cognitive assessment performance in patients with Parkinson’s disease with ‘normal’ global cognition according to mini-mental state examination score. J Am Geriatr Soc 2009;57:304–308.
Videnovic A, Bernard B, Fan W, Jaglin J, Leurgans S, Shannon KM: The Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in Huntington’s disease. Mov Disord 2010;25:401–404.
- Gagnon JF, Postuma RB, Joncas S, Desjardins C, Latreille V: The Montreal Cognitive Assessment: a screening tool for mild cognitive impairment in REM sleep behavior disorder. Mov Disord 2010;25:936–940.
- Olson RA, Chhanabhai T, McKenzie M: Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases. Support Care Cancer 2008;16:1273–1278.
- Copersino ML, Fals-Stewart W, Fitzmaurice G, Schretlen DJ, Sokoloff J, Weiss RD: Rapid cognitive screening of patients with substance use disorders. Exp Clin Psychopharmacol 2009;17:337–344.
- Luis CA, Keegan AP, Mullan M: Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry 2009;24:197–201.
- Adler CH, Connor DJ, Hentz JG, Sabbagh MN, Caviness JN, Shill HA, Noble B, Beach TG: Incidental Lewy body disease: clinical comparison to a control cohort. Mov Disord 2010;25:642–646.
- Caviness JN, Driver-Dunckley E, Connor DJ, Sabbagh MN, Hentz JG, Noble B, Evidente VG, Shill HA, Adler CH: Defining mild cognitive impairment in Parkinson’s disease. Mov Disord 2007;22:1272–1277.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.