Clinical application of the Polish adaptation of the Montreal Cognitive Assessment (MoCA) test in screening for cognitive impairment

Background and purposeThe Montreal Cognitive Assessment (MoCA) test is a brief cognitive screening tool with high sensitivity and specificity for detecting mild cognitive impairment (MCI). The aim of this study was to evaluate the usefulness of MoCA and compare it with the Mini-Mental State Examination (MMSE) in the early detection of cognitive decline in MCI.Material and methodsA group of 115 subjects (36 meeting DSM-IV criteria for Alzheimer disease (AD) [Clinical Dementia Rating (CDR) = 1], 42 meeting Petersen's criteria for MCI [CDR = 0.5], and 37 cognitively intact controls [CDR = 0]) was recruited for the study in the university-based Alzheimer out-patient clinic. All participants underwent general medical, neurological, and psychiatric examinations. The MoCA, the MMSE, CDR and the short (15-item) version of the Geriatric Depression Scale were also applied.ResultsBoth MCI and AD groups exhibited impaired performance on MoCA compared to controls. Polish versions of the MMSE and MoCA tests were comparable in discriminating mild dementia from both MCI and control groups. The Polish version of the MoCA test performed marginally better than MMSE in discriminating MCI from controls. We propose to use the MoCA test to screen for MCI using an optimal cut-off score of 24 and to screen for dementia using a cut-off score of 19.ConclusionsThe Polish version of the MoCA seems effective in the detection of deteriorated cognitive performance and appropriate for differentiating impaired from preserved cognitive function in a Polish population.     

Cognitive screening for adult psychiatric outpatients: Comparison of the Cognivue® to the Montreal Cognitive Assessment

In this editorial we comment on the article by Cahn-Hidalgo D published in a recent issue of the World Journal of Psychiatry 2020; 10(1); 1-11. We focus on the importance of utilizing psychometrically valid cognitive screening tools when assessing for cognitive decline in older adults in a psychiatric outpatient setting. We compared the use of Cognivue^® to use of the montreal cognitive assessment (MoCA) as a cognitive screening tool. A total of 58 patients aged 55 and over participated in this comparison study. Patients completed cognitive screening on Cognivue^®, a new Food and Drug Administration-cleared computer screening device, and the MoCA. The results of patient performance using these two instruments were analyzed. Sixteen (28%) patients screened negative for cognitive impairment on both assessments. Forty-two (72%) patients screened positive on one or both of the assessments. There was 43% agreement between Cognivue^® and the MoCA in identifying patients with cognitive impairment, and individual subtests were weakly correlated. The MoCA was determined to be the preferred instrument due to its high sensitivity and specificity (100% and 87%, respectively) when screening for cognitive impairment. We propose that the use of Cognivue^® cognitive screening tool be closely reviewed until more research proves that the test meets the standards for reliability and validity. It is important for clinicians to remember that screeners should not be used to diagnosis patients with neurocognitive disorders; instead, they should be used to determine whether further evaluation is warranted. Additionally, misdiagnosing of neurocognitive disorders can pose unnecessary psychological and emotional harm to patients and their families and also lead to incorrect treatment and undue healthcare costs.     

The Montreal Cognitive Assessment: A screening tool for mild cognitive impairment in REM sleep behavior disorder

Mild cognitive impairment (MCI) is a frequent feature in idiopathic REM sleep behavior disorder (RBD), a sleep disturbance that can be a preclinical stage of Parkinson's disease or Lewy body dementia. We evaluated the sensitivity and specificity of two brief screening tools, the Montreal Cognitive Assessment (MoCA) and the Mini‐Mental State Examination (MMSE), in detecting MCI in idiopathic RBD. Thirty‐eight idiopathic RBD patients underwent a comprehensive neuropsychological assessment, including the MoCA and the MMSE. Receiver operating characteristic curves were created for the MoCA and the MMSE to assess their ability to identify MCI in idiopathic RBD patients, with neuropsychological assessment as the gold standard. For the MoCA, a normality cutoff of 26 yielded the best balance between sensitivity (76%) and specificity (85%) with a correct classification of 79%. For the MMSE, the optimal normality cutoff was 30, with a sensitivity of 84% and a specificity of 54% and a correct classification of 74%. The MoCA is superior to the MMSE in detecting MCI in idiopathic RBD patients, showing good sensitivity and very good specificity. © 2010 Movement Disorder Society     

Neuropsychological screening tools in Italian HIV+ patients: a comparison of Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE)

Abstract

Objective: Despite the progress in HIV treatments, mild forms of cognitive impairment still persist. Brief and sensitive screening tools are needed. We evaluated the accuracy of the Montreal Cognitive Assessment (MoCA) compared to the Mini Mental State Examination (MMSE) to detect cognitive impairment in HIV-infected participants. Method: HIV-infected patients were consecutively enrolled during routine outpatient visits at a single institution. The MoCA, the MMSE, and a comprehensive neuropsychological battery were administered. Patients were considered as affected by cognitive impairment if they showed decreased cognitive function in at least two ability domains based on age and education adjusted Italian normative cut-offs. Results: Ninety-three HIV-infected participants (75% males, median age 47, all on antiretroviral therapy; 90% HIV-RNA <50copies/mL, median CD4 644 cells/μL) were enrolled. Thirteen participants (14%) were diagnosed as cognitively compromised via a comprehensive neuropsychological examination. The area under the curve of the adjusted MMSE and MoCA scores to detect cognitive impairment were .51 (95% CI = .31–.72, p = .877) and .70 (95% CI = .53–.86, p = .025), respectively. A MoCA score <22 was able to predict the cognitive impairment with 62% of sensitivity and 76% of specificity. Conclusions: Our findings suggested that the prognostic performance of the MoCA to detect cognitive impairment among mildly impaired HIV-infected participants was only moderate. Further investigations are needed to identify optimal cognitive tests to screen HIV-infected individuals or to explore whether a combination of cognitive tests might represent a viable alternative to a single screening tool.     

Detection of activity limitations in older adults with MCI or Alzheimer's disease through evaluation of perceived difficulty in use of everyday technology: a replication study

Objectives and methods: Earlier research indicates that the ability to use everyday technology (ET) may be sensitive to subtle functional change. People with mild cognitive impairment (MCI) have been identified as significantly more disabled in ET use compared to controls, albeit less disabled than people with dementia. The aim of this study was to investigate the replicability of these findings using an improved version of the Everyday Technology Use Questionnaire (ETUQ) to compare perceptions of relevance and difficulty in ET use in participants with MCI or Alzheimer's disease (AD) and controls. Additional aims were to explore the validity of ETUQ, and the relationships between perceived difficulty in ET use and cognitive status, mood state, and involvement in everyday life activities. In total, 118 participants were included, 37 with AD, 37 with MCI, and 44 controls.

Results: Analyses confirmed that the rating scale of the ETUQ functioned well. The three groups overlapped but differed significantly in their perceptions of ETs relevance (p?p?r?=?0.563).

Conclusion: Taken together, the findings underscore the plausibility of disability already in people with MCI, as the use of ET strongly correlates to involvement in activities. It is therefore important that professionals who meet older adults with cognitive impairment take this aspect of function into account in assessments and targeted interventions.     

The RAPID-II Neuropsychological Test battery for subjects aged 20 to 49 years: Norms and cognitive profile

Introduction

Cognitive evaluation of young subjects is now widely carried out for non-traumatic diseases such as multiple sclerosis, HIV, or sleep disorders. This evaluation requires normative data based on healthy adult samples. However, most clinicians use a set of tests that were normed in an isolated manner from different samples using different cutoff criteria. Thus, the score of an individual may be considered either normal or impaired according to the norms used. It is well established that healthy adults obtained low-test scores when a battery of tests is administered. Thus, the knowledge of low base rates is required so as to minimize false diagnosis of cognitive impairment. The aim of this study was twofold (1) to provide normative data for RAPID-II battery in healthy adults, and (2) estimate the proportion of healthy adults having low scores across this battery.

Cognitive and physical impact of cognitive-motor dual-task training in cognitively impaired older adults: An overview

Ageing is associated with cognitive decline, ranging from normal to mild cognitive impairment or dementia. This leads to physical and cognitive impairments, which are risk factors for loss of autonomy. Therefore, cognitive and physical training are important for cognitively impaired older adults. The combination of both may represent an efficiency advantage. This overview aims to summarize the effectiveness of cognitive-motor dual-task (CMDT) interventions on cognitive, physical and dual-task functions in cognitively impaired older adults, as well as the safety, adherence, and retention of benefits of these interventions. We searched for systematic reviews or meta-analyses assessing the effects of CMDT interventions on cognitive or physical functions in older adults with mild cognitive impairment or dementia through eight databases (CDSR (Cochrane), MEDLINE, Scopus, EMBASE, CINAHL, PsycINFO, ProQuest and SportDiscus). Two reviewers independently performed the selection, data extraction and risk of bias evaluation. Nine reviews were included in this overview. CMDT interventions were found to be more effective than active control groups on cognitive and physical functions in older adults with cognitive impairment, irrespective of intervention dose and modalities; no information on dual-task functions was available. Retention of benefits, adherence, need for supervision and safety are still unclear. These results should be interpreted with caution, considering the low average methodological quality of included reviews. Future intervention research should follow more rigorous methodological standards and focus on other forms of CMDT.     

Empirical evaluation of the ‘Cognitive Difficulties Scale’ for assessment of memory complaints in general practice: A study of 1628 cognitively normal subjects aged 45–75 years

The Cognitive Difficulties Scale (CDS, McNair and Kahn, 1984) was used to assess memory complaints in 1648 subjects devoid of severe medical or psychiatric disorder. The subjects, aged 45–75 years, were recruited when visiting their general practitioner. The CDS was well accepted and showed a good and stable factorial structure. A weak correlation was found between CDS score and the results of a short neuropsychological battery. A high CDS score was associated with advancing age, low educational level, and psychological motives for visiting. A reduced 26-item version is proposed to shorten the time required to fill in the scale.     

Differentiating levels of cognitive functioning: a comparison of the Brief Interview for Mental Status (BIMS) and the Brief Cognitive Assessment Tool (BCAT) in a nursing home sample

Objectives: In US nursing homes, cognitive assessment has been an essential component of the federally mandated Minimum Data Set assessment system, inclusive of the Brief Interview for Mental Status (BIMS) for identifying possible cognitive impairment. We compare it with the Brief Cognitive Assessment Tool (BCAT) to determine which instrument is more sensitive in differentiating degrees of cognitive functioning in nursing home residents. We attempt to cross-validate the psychometric properties of both measures.

Method: Two hundred twenty-nine individuals residing in a Maryland skilled nursing facility were referred for neurocognitive evaluation over a 10-month period. One hundred eighty-nine of these residents met inclusion criteria by completing the BCAT and BIMS, and were aged 60 or older.

Results: The BIMS and the BCAT were confirmed to have strong internal consistency reliability and construct validity. Both cognitive tools were found to predict cognitive diagnoses generally, but only the BCAT was able to identify residents at all specific cognitive levels. The BIMS did not differentiate between residents with normal cognition and those with mild cognitive impairment, or between mild and moderate dementia. Both measures demonstrated high specificity and positive predictive values for identifying severe cognitive impairment or probable dementia. The BIMS had lower sensitivity and negative predictive values for identifying dementia compared to the BCAT. The BCAT accounted for an additional 47% of the variance in dementia diagnoses over and above BIMS scores.

Conclusion: Based on these findings, the BCAT appears to be more sensitive than the BIMS in predicting cognitive level for nursing home residents.