Abstract:INTRODUCTION: This systematic review evaluates the accuracy of the Montreal Cognitive Assessment (MoCA) for detecting mild cognitive impairment (MCI). METHODS: We searched MEDLINE, PSYCInfo, EMBASE, and Cochrane CENTRAL for studies comparing the MoCA with validated diagnostic criteria to identify MCI in general practice. Screening, data extraction, and risk of bias assessment were performed independently, in duplicate. Pooled sensitivity and specificity for MoCA cutoffs were estimated using bivariate meta-ana… Show more
“…Although, the most commonly used cut-off of MoCA for MCI in the general population is 26 (score < 26 abnormal), there are studies which have found that this widely recommended cut-off leads to an inflated rate of false positives, (particularly in the elderly and people with lower education), and the cut-off score of 23 yields the best diagnostic accuracy [ 12 ]. A recently published systematic review evaluating the accuracy of MoCA for detecting mild cognitive impairment in the general population (13 studies, 2158 participants, 44% with MCI, mean age 72 years, mean education 13.5 years, race 93.4% Caucasian) also supports a lower cut-off [ 21 ]. In this meta-analysis, sensitivity and specificity were 73.5% and 91.3% respectively at cut-off < 23, while 93.7% and 58.8%, respectively, at cut-off < 26.…”
Introduction
Guidelines recommend screening older people (> 60–65 years) with type 2 diabetes (T2D) for cognitive impairment, as it has implications in the management of diabetes. The Montreal Cognitive Assessment (MoCA) is a sensitive test for the detection of mild cognitive impairment (MCI) in the general population, but its validity in T2D has not been established.
Methods
We administered MoCA to patients with T2D (age ≥ 60 years) and controls (no T2D), along with a culturally validated neuropsychological battery and functional activity questionnaire
.
MCI was defined as performance in one or more cognitive domains ≥ 1.0 SD below the control group (on two tests representing a cognitive domain), with preserved functional activities. The discriminant validity of MoCA for the diagnosis of MCI at different cut-offs was ascertained.
Results
We enrolled 267 patients with T2D and 120 controls; 39% of the participants with T2D met the diagnostic criteria for MCI on detailed neuropsychological testing. At the recommended cut-off on MoCA (< 26), the sensitivity (94.2%) was high, but the specificity was quite low (29.5%). The cut-off score of < 23 showed an optimal trade-off between sensitivity (69.2%), specificity (71.8%), and diagnostic accuracy (70.8%). The cut-off of < 21 exhibited the highest diagnostic accuracy (74.9%) with an excellent specificity (91.4%), a good positive and negative predictive value (78.5% and 73.7%, respectively).
Conclusions
The recommended screening cut-off point on MoCA of < 26 has a suboptimal specificity and may increase the referral burden in memory clinics. A lower cut-off of < 21 on MoCA maximizes the diagnostic accuracy.
Interactive Visual Abstract available for this article.
“…Although, the most commonly used cut-off of MoCA for MCI in the general population is 26 (score < 26 abnormal), there are studies which have found that this widely recommended cut-off leads to an inflated rate of false positives, (particularly in the elderly and people with lower education), and the cut-off score of 23 yields the best diagnostic accuracy [ 12 ]. A recently published systematic review evaluating the accuracy of MoCA for detecting mild cognitive impairment in the general population (13 studies, 2158 participants, 44% with MCI, mean age 72 years, mean education 13.5 years, race 93.4% Caucasian) also supports a lower cut-off [ 21 ]. In this meta-analysis, sensitivity and specificity were 73.5% and 91.3% respectively at cut-off < 23, while 93.7% and 58.8%, respectively, at cut-off < 26.…”
Introduction
Guidelines recommend screening older people (> 60–65 years) with type 2 diabetes (T2D) for cognitive impairment, as it has implications in the management of diabetes. The Montreal Cognitive Assessment (MoCA) is a sensitive test for the detection of mild cognitive impairment (MCI) in the general population, but its validity in T2D has not been established.
Methods
We administered MoCA to patients with T2D (age ≥ 60 years) and controls (no T2D), along with a culturally validated neuropsychological battery and functional activity questionnaire
.
MCI was defined as performance in one or more cognitive domains ≥ 1.0 SD below the control group (on two tests representing a cognitive domain), with preserved functional activities. The discriminant validity of MoCA for the diagnosis of MCI at different cut-offs was ascertained.
Results
We enrolled 267 patients with T2D and 120 controls; 39% of the participants with T2D met the diagnostic criteria for MCI on detailed neuropsychological testing. At the recommended cut-off on MoCA (< 26), the sensitivity (94.2%) was high, but the specificity was quite low (29.5%). The cut-off score of < 23 showed an optimal trade-off between sensitivity (69.2%), specificity (71.8%), and diagnostic accuracy (70.8%). The cut-off of < 21 exhibited the highest diagnostic accuracy (74.9%) with an excellent specificity (91.4%), a good positive and negative predictive value (78.5% and 73.7%, respectively).
Conclusions
The recommended screening cut-off point on MoCA of < 26 has a suboptimal specificity and may increase the referral burden in memory clinics. A lower cut-off of < 21 on MoCA maximizes the diagnostic accuracy.
Interactive Visual Abstract available for this article.
“…The MoCA Full was selected due to its high sensitivity and specificity profile; reliability across multiple language, culture, and sensory needs; and validity when administered by trained non‐clinicians 11 , 12 , 13 compared to other less sensitive or culturally specific screening tools (e.g., 3MS, Eight‐Item Informant Interview to Differentiate Aging and Dementia [AD8], Short Portable Mental Status Questionnaire [SPMSQ]). CASS staff and associated researchers underwent MoCA training and certification.…”
INTRODUCTIONOlder adults represent the fastest growing segment of the homeless community. Little is known about the prevalence of dementia and mild cognitive impairment (MCI) in this population.METHODSDementia and MCI screening using the Montreal Cognitive Assessment (MoCA) was incorporated into the standard senior evaluation for adult clients aged ≥ 55 in a large emergency homeless shelter.RESULTSIn a 6‐week period, 104 of 112 (92.9%) assessments were positive for dementia or MCI using a standard cutoff of 26, and 81 (72.3%) were positive using a conservative cutoff of 23. There was no significant difference in MoCA scores based on sex or education level, and no significant correlation between age and MoCA score.DISCUSSIONOlder adults experiencing homelessness may have a high likelihood of dementia or MCI. Routine MoCA screening in older adults experiencing homelessness is feasible and can help to identify services needed to successfully exit homelessness.
“…Finally, older participants completed the Montreal Cognitive Assessment (MOCA) to screen for any mild cognitive impairment. All older participants were above the threshold (MOCA Score ≥ 23) indicating no mild cognitive impairment 84 , 85 . Figure 5 Behavioral tasks.…”
Normal aging often results in an increase in physiological tremors and slowing of the movement of the hands, which can impair daily activities and quality of life. This study, using lightweight wearable non-invasive sensors, aimed to detect and identify age-related changes in wrist kinematics and response latency. Eighteen young (ages 18–20) and nine older (ages 49–57) adults performed two standard tasks with wearable inertial measurement units on their wrists. Frequency analysis revealed 5 kinematic variables distinguishing older from younger adults in a postural task, with best discrimination occurring in the 9–13 Hz range, agreeing with previously identified frequency range of age-related tremors, and achieving excellent classifier performance (0.86 AUROC score and 89% accuracy). In a second pronation–supination task, analysis of angular velocity in the roll axis identified a 71 ms delay in initiating arm movement in the older adults. This study demonstrates that an analysis of simple kinematic variables sampled at 100 Hz frequency with commercially available sensors is reliable, sensitive, and accurate at detecting age-related increases in physiological tremor and motor slowing. It remains to be seen if such sensitive methods may be accurate in distinguishing physiological tremors from tremors that occur in neurological diseases, such as Parkinson’s Disease.
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