Prospective comparison of two cognitive screening tests: diagnostic accuracy and correlation with community integration and quality of life

Abstract

Cognitive screening tests are frequently used in brain tumor clinics. The Mini Mental State Examination (MMSE) is the most commonly used, and the Montreal Cognitive Assessment (MoCA) is an alternative. This study compares the diagnostic accuracy of both screening tests. Fifty-eight patients with brain tumors were prospectively accrued and administered the MMSE and MoCA, 67% of who completed a comprehensive neuropsychological evaluation as a gold standard comparison. Quality of life and community integration were measured with the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Community Integration Questionnaire (CIQ), respectively. At the pre-defined cut-off scores, the MoCA had superior sensitivity (61.9% vs. 19.0%, P < 0.005) and the MMSE had superior specificity (94.4% vs. 55.6%, P < 0.017). The areas under the ROC curve for the MMSE (0.615, standard error = 0.091) and MoCA (0.606, standard error = 0.092) were poor, indicating that at no single cut-off score is either test both sensitive and specific. Neither the MMSE (ρ = 0.12; P < 0.444) nor MoCA (ρ = 0.24; P < 0.108) were significantly correlated with the FACT-Br. The MoCA was modestly correlated with the CIQ (ρ = 0.35; P < 0.017), but the MMSE was not (ρ = 0.14; P < 0.359). The MMSE has extremely poor sensitivity. Using this test in clinical practice, research, and clinical trials will result in failing to detect cognitive impairment in a substantial percentage of patients. The MoCA has superior sensitivity, and is better correlated with self reported measures of community integration, and therefore should be preferentially chosen in practice and clinical trials.

Cognitive and neuropsychiatric impairment in cerebral radionecrosis patients after radiotherapy of nasopharyngeal carcinoma

“…Both MMSE and MoCA were widely used cognitive screens, and MoCA has previous been documented to have superior sensitivity in brain tumor patients [13,14]. The time to administer each test was recorded.…”

Cognitive Screening in Brain Tumors: Short but Sensitive Enough?

“…For brain tumors, cognitive assessment (CA) can inform clinicians of areas to target for neurorehabilitation (3), monitor progress to facilitate decision making about further intervention (4), and if there has been a decline in cognitive function, address the question of whether the tumor has recurred or progressed (3). In addition, a CA is able to address the question of whether subtle alterations in cognitive function are significant or not, particularly when monitoring slow-growing low-grade gliomas (4).…”

Canadian Academy of Geriatric Psychiatry Survey of Brief Cognitive Screening Instruments

“…(17) Our finding that by 2010 the MoCA was used often or routinely by 80% of Canadian psychogeriatric clinicians is quite remarkable, given that the MoCA was designed specifically to detect MCI. However, recent literature supports the use of the MoCA in a number of different areas including neurooncology, (18) stroke, (19,20) HIV, (21) Parkinson’s Disease, (22) and Huntington’s Disease (23) — all consistent with the increasing popularity of this instrument. In our survey, ease of scoring, effectiveness, ease of administration, and tolerability were the most significant perceived characteristics correlated with the use of the MoCA.…”