The Montreal Cognitive Assessment and the Mini-Mental State Examination as Screening Instruments for Cognitive Impairment: Item Analyses and Threshold Scores

Abstract

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.

Reducing perceptual interference improves visual discrimination in mild cognitive impairment: Implications for a model of perirhinal cortex function

“…To provide further evidence in a related participant group and to increase our sample size, we also administered the task to older adults at risk for MCI, on the assumption that the integrity of the PRC would already be compromised in the earliest stages of the disorder (e.g., Du et al, 2001;Loewenstein et al, 2009;Schmidt-Wilcke et al, 2009). We identified these individuals at risk for MCI based on the Montreal Cognitive Assessment (MoCA), a brief standardized neuropsychological measure shown to be extremely sensitive in distinguishing controls from MCI patients (Nasreddine et al, 2005;Damian et al, 2011). Consistent with the cut-off scores provided by the developers of the MoCA (Nasreddine et al, 2005), we included older adults who scored below 26/30 on the MoCA as at risk for MCI, and older adults who scored 26/ 30 or above as a healthy control group.…”

Validation Study of the Italian Addenbrooke’s Cognitive Examination Revised in a Young-Old and Old-Old Population

“…Different psychometric tests have been proposed for screening purposes [2,3]. The Mini Mental State Examination (MMSE) is the most popular and is widely used to follow cognitive decline along with time as well as to monitor the effects of drug treatments [4].…”

Alzheimer’s Disease: A Clinical Perspective

“…The American Academy of Neurology guidelines suggested to use the Mini-Mental Status Examination [66], and the Memory Impairment Screen (MIS) [67]. In recent times, the Montreal Cognitive Assessment (MoCA) was developed as a tool to screen patients in who has been hypothesized a mild cognitive decline and usually performed in the normal range on the MMSE [68,69]. Studies have shown that MoCa is sensitive for the mild stages of AD dementia, whereas MMSE is superior for more advanced stages with the functional impairment.…”