Underestimation of Cognitive Impairment by Mini-Mental State Examination Versus the Montreal Cognitive Assessment in Patients With Transient Ischemic Attack and Stroke

Abstract

Background and Purpose-The Mini-Mental State Examination (MMSE) is insensitive to mild cognitive impairment and executive function. The more recently developed Montreal Cognitive Assessment (MoCA), an alternative, brief 30-point global cognitive screen, might pick up more cognitive abnormalities in patients with cerebrovascular disease. Methods-In a population-based study (Oxford Vascular Study) of transient ischemic attack and stroke, the MMSE and MoCA were administered to consecutive patients at 6-month or 5-year follow-up. Accepted cutoffs of MMSE Ͻ27 and MoCA Ͻ26 were taken to indicate cognitive impairment. Results-Of 493 patients, 413 (84%) were testable. Untestable patients were older (75.5 versus 69.9 years, PϽ0.001) and often had dysphasia (24%) or dementia (15%). Although MMSE and MoCA scores were highly correlated (r

Montreal Cognitive Assessment (MoCA): Validation Study for Vascular Dementia

“…With this cutoff point, the MoCA showed good sensitivity (77%), excellent specificity (97%) and PPV (96%), and good NPV (81%) and classification accuracy (87%). With an optimal cutoff point of below 26 points, the MMSE had consistently lower respective values, namely in sensitivity (62%) and classificatory accuracy (78%); this suggests that the MMSE is not a good option as cognitive screening instrument for VaD, as some authors have claimed (Hachinski et al, 2006;Moorhouse & Rockwood, 2008;Pendlebury et al, 2010;Román, 2003). The main reasons for the MoCA's higher results at this level were the inclusion of the executive function assessment and the consideration of more complex tasks to measure short-term memory, language, attention, concentration, working memory, and visuospatial skills.…”

The Montreal Cognitive Assessment (MoCA) in Multiple Sclerosis: Relation to Clinical Features

“…The mean MoCA of 25.86 ± 2.92 in our sample was similar to a smaller sample of individuals with MS [27], 26.02± 2.30 and is in the same range as other neurologic disorders associated with mild cognitive impairment including REM Sleep Behavior Disorder [34] (n=38, 24.34 ± 3.50), or early Parkinson's disease [7] (n=100, 24.9 ±3.1), but is considerably higher than individuals with brain metastasis [36](n=40, 20.53 ± -5.15), cerebral small vessel disease [37] (n=40, 19.2 ± 4.2), Huntington's disease [9](n=53, 21 ±4.4) or Alzheimer's disease [3](n=321,13.0 4 ±6.05) [4,[7][8][9]27,[36][37][38][39].…”

“…These patients usually score normally on the MMSE but fall below normal range on the MoCA [3,[6][7][8][9].An extensive list of diseases for which the MoCA has been used as an assessment tool can be found on the MoCA website, www.mocatest.org [1].…”

“…The most commonly-used cognitive screening instrument for the general neurologist, the Mini-Mental State Exam (MMSE), has a ceiling effect for those with milder deficits (e.g. patients with mild cognitive impairment or MCI often score in the normal range [2,8,4]) and therefore is not sensitive enough for use in MS. Instead, deficits in MS are often found only with more extensive neuropsychological testing [13,19].…”

Social Function and Cognitive Status: Results from a US Nationally Representative Survey of Older Adults

“…Cognitive assessments have relied on dementia diagnoses or have used screening tools, such as the Short Portable Mental Status Questionnaire (SPMSQ), 21,23,24 or the MiniMental Status Exam (MMSE), 8,10,25 which are relatively insensitive to early impairment. [26][27][28] Clinicians would benefit from understanding whether early stages of impairment are associated with altered social relationships.…”