The Optimal Short Version of Montreal Cognitive Assessment in Diagnosing Mild Cognitive Impairment and Dementia

Liew, Tau Ming

doi:10.1016/j.jamda.2019.02.004

Cited by 21 publications

(29 citation statements)

References 27 publications

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“…The apparently normal cognition during the initial evaluations may not be sufficient to exclude underlying neurodegenerative processes, and there remains a need for continued and close surveillance to detect the onset of cognitive decline in this group of individuals. The findings may have implications to the future diagnostic criteria of late-life psychotic disorders, suggesting the need for greater clarity on the extent of clinical investigations in the diagnostic criteriasuch as specifying the need for repeated administration of a neuropsychological battery (or in its absence, another briefer but sensitive cognitive test such as the Montreal Cognitive Assessment) [27,28,62,63]-before a diagnosis of late-life psychotic disorder can be accurately made. Potentially, the future diagnostic criteria of late-life psychotic disorders may also incorporate the newer biomarkers of dementia (such as those related to amyloid protein, tau protein, and neuronal injury) [10] to definitively exclude underlying neurodegenerative processes, especially when these biomarkers become more accessible to general clinicians in the foreseeable future.…”

Section: Potential Implications Of the Findingsmentioning

confidence: 99%

Neuropsychiatric symptoms in cognitively normal older persons, and the association with Alzheimer’s and non-Alzheimer’s dementia

Liew

2020

Alz Res Therapy

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Background: Neuropsychiatric symptoms (NPS) have been reported to be useful in predicting incident dementia among cognitively normal older persons. However, the literature has not been conclusive on the differential utilities of the various NPS in predicting the subtypes of dementia. This study compared the risks of Alzheimer's and non-Alzheimer's dementia associated with the various NPS, among cognitively normal older persons. Methods: This cohort study included 12,452 participants from the Alzheimer's Disease Centers across USA, who were ≥ 60 years and had normal cognition at baseline. Participants completed the Neuropsychiatric Inventory-Questionnaire at baseline and were followed up almost annually for incident dementia (median follow-up = 4.7 years). Symptom clusters of NPS-as identified from exploratory and confirmatory factor-analyses-were included in the Cox regression to investigate their associations with incident dementia. Results: The various NPS showed independent yet differential associations with incident dementia. Although psychotic symptoms were rarely endorsed by the participants, they predicted much higher risk of dementia (HR 3.6, 95% CI 2.0-6.4) than affective symptoms (HR 1.5, 95% CI 1.2-1.8) or agitation symptoms (HR 1.6, 95% CI 1.3-2.1). Psychotic symptoms predicted all dementia subtypes, while affective and agitation symptoms differentially predicted some subtypes. Across dementia subtypes, psychotic symptoms had relatively higher risk estimates than affective or agitation symptoms, with the risk estimates being particularly high in non-Alzheimer's dementia. Conclusions: Among cognitively normal individuals, the presence of NPS may warrant greater clinical vigilance as precursors to dementia and its subtypes. The findings highlight the need for further research to enrich our understanding on the neurobiological links between various NPS and dementia subtypes. They may also change the clinical approach in managing late-life psychotic symptoms, requiring a greater emphasis on dementia surveillance in the diagnostic criteria of late-life psychotic disorders.

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Section: Potential Implications Of the Findingsmentioning

confidence: 99%

Neuropsychiatric symptoms in cognitively normal older persons, and the association with Alzheimer’s and non-Alzheimer’s dementia

Liew

2020

Alz Res Therapy

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“…Compared to other instruments available for MCI and early dementia diagnosis, for example CERAD and MoCA, accuracy for CAB seems to be worse. The original MoCA version has an AUC of 0.893 and the shorter MoCA versions by Roal et al and Wong et al demonstrated comparable AUC values of 88.4-88.9% (134,147,148). CERAD had an excellent AUC in one longitudinal PHC population but the result needs to be revalidated (91).…”

Section: Cognitive Assessment Batterymentioning

confidence: 97%

“…One modern example is the cognitive instrument MoCA, which in recent years has been introduced as a possible alternative, especially for detection of MCI and early dementia (77). Short versions of MoCA applicable for PHC has also been studied as an alternative (134). We do have normative values of MoCA results in Sweden but worldwide PHC data are scarce (76).…”

Section: Papermentioning

confidence: 99%

Dementia diagnostics in primary care : with a focus on cognitive testing

Kvitting

2019

Linköping University Medical Dissertations

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“…In general, AUC > 0.9 is deemed to be excellent performance [50] and indicates that a strategy has a low error rate (<10%) and is suitable for case-finding purposes. AUC was also compared among the three strategies via a non-parametric approach proposed by DeLong et al [20,21,31,[51][52][53] with statistically significant differences defined as P ≤ 0.05 and clinically significant differences defined as AUC differences of ≥1% (when a test is used for case finding in a large population of one million people, a 1% difference in AUC would have translated into an additional 10 000 people being misclassified) [21].…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Conventionally, three strategies can be employed in the case finding of dementia, i.e. using informant reports alone [such as AD8 and Functional Activities Questionnaire (FAQ)] [17,18], brief cognitive tests alone [such as Mini-Cog and short variants of Montreal Cognitive Assessment (MoCA)] [19][20][21][22] and combined measures that pair informant reports with brief cognitive tests [23][24][25][26][27][28][29]. Each case-finding strategy has inherent strengths and limitations, with the literature remaining unclear on the right strategy to adopt across different healthcare services with varying clinical resources and patient profiles.…”

Section: Introductionmentioning

confidence: 99%

Active case finding of dementia in ambulatory care settings: a comparison of three strategies

Liew

2020

Euro J of Neurology

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Background and purpose To reduce the diagnostic gap of dementia, three strategies can be employed for case finding of cognitive impairment in ambulatory care settings, namely using informant report, brief cognitive test or a combination of informant report and brief cognitive test. The right strategy to adopt across different healthcare settings remains unclear. This diagnostic study compared the performance of the three strategies for detecting dementia (primary aim), as well as for detecting both mild cognitive impairment (MCI) and dementia (secondary aim). Methods Participants aged ≥65 years (n = 11 057) were recruited from Alzheimer’s Disease Centers across the USA. Participants provided data on an informant report (Functional Activities Questionnaire), brief cognitive test (four‐item short variant of Montreal Cognitive Assessment) and a combined measure with informant report and brief cognitive test (sum of Functional Activities Questionnaire and Montreal Cognitive Assessment short variant). They also received standardized assessments (clinical history, physical examination and neuropsychological testing) to diagnose MCI and dementia. Areas under the receiver operating characteristic curve (AUCs) of the three strategies were compared using the DeLong method, with AUC > 90% indicating excellent performance. Results All three strategies had excellent performance in detecting dementia, although informant report [AUC, 95.9%; 95% confidence intervals (CI), 95.4–96.3%] was significantly better than brief cognitive test (AUC, 93.0%; 95% CI, 92.4–93.6%) and the combined measure had the best performance (AUC, 97.0%; 95% CI, 96.7–97.4%). However, to detect both MCI and dementia, only the combined measure had excellent performance (AUC, 93.0%; 95% CI, 92.5–93.4%), whereas stand‐alone informant report or brief cognitive test performed suboptimally (AUC < 90%). Performance of the three strategies was not affected by participants’ age, educational attainment or underlying prevalence of MCI and dementia. Conclusions For case finding of dementia in ambulatory care settings, informant reports would suffice as first‐line measures and brief cognitive tests may optionally be added on, in services with available resources, to further improve the accuracy of detection. For case finding of both MCI and dementia, a combination of informant reports and brief cognitive tests remains the most appropriate strategy.

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The Optimal Short Version of Montreal Cognitive Assessment in Diagnosing Mild Cognitive Impairment and Dementia

Cited by 21 publications

References 27 publications

Neuropsychiatric symptoms in cognitively normal older persons, and the association with Alzheimer’s and non-Alzheimer’s dementia

Neuropsychiatric symptoms in cognitively normal older persons, and the association with Alzheimer’s and non-Alzheimer’s dementia

Dementia diagnostics in primary care : with a focus on cognitive testing

Active case finding of dementia in ambulatory care settings: a comparison of three strategies

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