The MoCA detected more patients with executive dysfunction than the MMSE (OR 15.399, 95% CI 12.631-18.773; P < 0.001). 2019;16(16):2847. https://doi.org/10.3390/ijerph16162847. [, Pagonabarraga J, Kulisevsky J, Llebaria G, Garca-Snchez C, Pascual-Sedano B, Gironell A. Parkinsons disease-cognitive rating scale: a new cognitive scale specific for Parkinsons disease. Receiver Operating Characteristic (ROC) analysis for MCI versus AD dementia was performed to obtain cutoff values with sensitivity and specificity for MoCA scores. Neuropsychological criteria for mild cognitive impairment improves diagnostic precision, biomarker associations, and progression rates. 1999;32(3):14953. J Psychiatr Res. Data used in preparation of this article were obtained from the Alzheimers Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). The sensitivity and specificity of both measures were assessed for detection of MCI and dementia. The observed significantly increased likelihood of incorrect MMSE executive, naming, repetition, visuoconstructional, and recall tasks across decreasing scores of MoCA corresponding tasks (Fig. The funding source had no involvement in the research and article preparation, such as study design, data collection, analysis and interpretation, writing the manuscript and the decision to submit the article for publication. Attention deficit was a score 4 on the Backward Digit Span, as recommended for the elderly.24 Finally, visuospatial deficit was a score of 02 on a 5-point scale scoring method for Cube Copying.25 Due to impaired color discrimination, approximately 10% of subjects were unable to perform the Stroop. Pendlebury ST, Cuthbertson FC, Welch SJ, Mehta Z, Rothwell PM. Accepted in final form August 20, 2009. A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study. The optimal cutoff MMSE scores for MCI and dementia were 27 and 24, respectively. Odessa, FL: Psychological Assessment Resources; 1988. Patients with only minor cognitive impairment may be overlooked if this is the principal screening tool used.. Results demonstrate that data-driven techniques applied in archival clinical datasets could enhance diagnostic procedures in regions with limited resources. Percentile analysis showed presence of ceiling effect (maximum total score on the 75th percentile) for MMSE in several subgroups of 5564years, education of high school and above, high level of monthly household income, urban and suburban areas of residence, but for MoCA only in subgroups with high monthly household income level and living in urban area. Lessigs study found that the MoCA is more sensitive to subtle cognitive deficits in patients with Parkinsons disease compared with the MMSE, though the MMSE is the more commonly used test. 2017;33(3):32537. Neither test is very detail oriented and both would likely be used only for initial screening. . Generating an ePub file may take a long time, please be patient. ACE-R (20 min test): sensitivity of 92% and specificity of 89%. Regardless of diagnosis, 37.1% of the study population had deficits in 2 domains, 22.7% had deficits in 1 domain, and 40.2% had no domain deficits. Morley JE. Nearly all of the HCs scored in the upper right quadrant with 99.5% above the MoCA cutoff of 17 and 99.5% above the MMSE 24 cutoff. The MoCA ROC AUC (95% CI) = 0.87 (0.80-0.93) and MMSE ROC AUC (95% CI) = 0.77 (0.69-0.85). Pendlebury ST, Markwick A, de Jager CA, Zamboni G, Wilcock GK, Rothwell PM. We certainly dont want patients to be uncomfortable. The optimal screening cutoff points were 25/26 (sensitivity = 0.86, specificity = 0.72) for the MoCA and 29/30 (sensitivity = 0.92, specificity = 0.42) for the MMSE. We studied 618 cases from 219 cognitively normal HC, 299 MCI, and 100AD dementia cases. Thats certainly fine as a composite measure over time, but the MMSE is relatively insensitive to mild disease, says Roy Hamilton, MD, MS, an assistant professor of neurology at the University of Pennsylvania in Philadelphia. Based on the distribution of each cognitive domain subscore in total samples assessed by different items of MMSE and MoCA (Table4), the performance of execution, repetition and registration among 75% subjects using MMSE met maximum scores, whereas executive and recall dysfunctions were found in about 75% participants by MoCA test. Our research purpose differed from prior reports comparing the MoCA to the MMSE in that we wished to establish a MoCA score range that captures as many MCI cases as reasonable, including those at a very early stage, as designated using ADNI study criteria. Findings in this study may yield profound implications for the selection of cognitive measures and MCI management. An interesting finding of our study regards apparent limitations in the value of self-report of cognitive decline and functional impairment in the context of a clinical research interview. 44.4 for example). Springer Nature. From the Departments of Psychiatry (S.H., S.N., D.W.), Neurology (A.D.S., J.E.D., M.B.S., D.W.), and Biostatistics and Epidemiology (S.X.X. The MMSE had a sensitivity of 25% to detect subjects with dementia, whereas the MoCA detected 94%. And written informed consent was obtained for each participant. MoCA scores for MCI subjects were detected as abnormal in 73% of those whose MMSE was normal. Since the MoCA is a more difficult test than the MMSE, detection of cognitive impairment may be even better when the MoCA is used alone than what is reported here if an ordering effect had occurred. And the protective role of employment was attributed to increased reserve and the ability to tolerate higher levels of neuropathology thereby maintained their cognitive functioning [2], on the other hand, employment status would get access to higher social engagement, which was beneficial for MCI prevention [2, 19]. For mild impairment, the MoCA is the better test, says Abhay Moghekar, MBBS, an assistant professor of neurology at The Johns Hopkins University School of Medicine in Baltimore. Items address orientation, memory, recall, attention, naming objects, following verbal and written commands, writing a sentence, and copying a figure. We conducted systematic assessment of risk factors for MCI, to some extent, including demographic factors, lifestyle, psychological factors and cardiovascular risk factors. The prevalence of mild cognitive impairment in diverse geographical and Ethnocultural regions: the COSMIC collaboration. The discriminant validity of the MoCA and MMSE as screening and diagnostic instruments was ascertained. But a certain amount of anxiety is ubiquitous to these tests, says Hamilton. Figure1 scatterplots show the score distribution relationships between MMSE and MoCA, coded by diagnostic group and with lines denoting various possible cutoff scores. Using ROC analysis for MCI versus AD dementia, MoCA cutoff values of 17 to 19 were chosen to relatively emphasize sensitivity (92.3 to 87.3%) over specificity (58 to 77%). PubMed Clinicians need to better understand the relationship between MoCA and MMSE scores. Montreal Cognitive Assessment performance in patients with Parkinsons disease with normal global cognition according to Mini-mental State Examination score. Miyawaki CE, Liu M. Gender differences in cognitive impairment among the old and the oldest-old in China. Authors Age Ageing 1999;28:3943. The Functional Activities Questionnaire (FAQ) [24] measures instrumental activities of daily living (IADLs), such as preparing balanced meals and managing personal finances. This study further focused on cognitive domain subtests by MMSE and MoCA. "If you wish to continue using the MoCA Test without being officially trained and certified, you will be at increased risk for. Conclusions The MoCA is a valid screening tool for post-stroke cognitive impairment; it is more sensitive but less specific than the MMSE. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Here, 12.7% of total subjects with a normal MMSE score actually tested positive for MCI according to MoCAs adjusted cutoff points, partly reflecting higher sensitivity for MCI in MoCA although no comparison with the gold standard method was performed. A practical method for grading the cognitive state of patients for the clinician. Dementia is a major challenge for global public health [].Currently, more than 46 million people worldwide suffer from dementia, and it is estimated that this number will increase to 131.5 million by 2050 [].As the most populous country in the world, the number of dementia patients in China accounts for approximately 25% of the total number of dementia cases in the world []. Methods: These results also suggest specific fine-grained cognitive and behavioural measures may aid in the diagnosis of AD and FTD in LAC. Bossuyt PM, Reitsma JB, Bruns DE, et al. A cutoff of 17 on the MoCA may help capture early and late MCI cases; depending on the level of sensitivity desired, 18 or 19 could be used. 2021;13(4):1341. https://doi.org/10.3390/nu13041341. Mov Disord 2008;23:10431046. Receiver-operating characteristic (ROC) curves were calculated. Diet-cognition associations differ in mild cognitive impairment subtypes. Statistical analysis was carried out using SAS 9.4 (SAS Inc., Cary, NC, USA). 2014;10(4):43947. MMSE only achieved sensitivity 70% at a cutoff . Dr. Weintraub has served on a scientific advisory board for Boehringer Ingelheim; serves on the editorial board of Movement Disorders; has received honoraria from Boehringer Ingelheim, ACADIA Pharmaceuticals Inc., Novartis, Osmotica Pharmaceutical Corp., BrainCells Inc., Merck Serono, Sanofi-Aventis, and Pfizer Inc.; and receives research support from Boehringer Ingelheim and the NIH [K23 MH067894 (Principal Investigator)]. Gerontologist. Google Scholar. It performed similarly to the MMSE overall, but was superior as a screening instrument. The agreement between MMSE and MoCA to detect MCI was obtained by Kappa value. Unable to load your collection due to an error, Unable to load your delegates due to an error. In addressing cognitive screening tools, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are the most commonly used methods in cognitive impairment detection in both clinical and research fields [5,6,7,8]. The MoCA executive tasks are more sensitive in detecting executive dysfunction compared with the MMSE executive tasks. Ann Intern Med 2003;138:4044. MMSE and MoCA were conducted strictly face to face following the guidelines and protocols by trained investigators and were completed during 510min and 1015min, respectively. Objective cognition was assessed by Chinese versions of MMSE and MoCA, and total score and subscores of cognitive domains were calculated for each. Of the 11 remaining tests, two stood out as being 'better' than the MMSE. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. People with low education theoretically display a steeper cognitive decline early in the process of aging compared to those with high level of education. Galvin and Sadowski recently wrote clinical recommendations for primary care physician evaluation of older patients for cognitive impairment, emphasizing the need to look for early warning signs where formal cognitive testing can aid detection [1]. https://doi.org/10.1016/j.hrtlng.2014.05.011. His group (2020) recently conducted a large national study across different socioeconomic and geographic regions in 12 provinces and municipalities in China and found that the overall MCI prevalence was estimated at 15.5% in people aged 60years or older, representing 38.77 million people nationwide [46]. The diagnosis of possible or probable PD was confirmed by the patients movement disorder neurologist according to established criteria.19 Patients who had undergone deep brain stimulation (DBS) within the previous 6 months were excluded from the study. 2), suggested the higher sensitivity of the MoCA in detecting dysfunctions of abovementioned cognitive domains, which may be related to more components of each domain in MoCA [28]. A cutoff of 17 on the MoCA may help capture early and late MCI cases; depending on the level of sensitivity desired, 18 or 19 could be used. OBryant SE, Humphreys JD, Smith GE IR, Graff-Radford NR, Petersen RC, Lucas JA. When standardized scores were available, a score 1.5 SD below the published normative data mean was considered to represent a deficit, which is consistent with previous PD research.3,6 Memory deficit was defined as 1.5 SD below the published normative data mean on at least 1 of 2 HVLT measures (immediate free recall or recognition discrimination). Researches to date have identified several factors, such as age, gender, educational and occupational attainment, marriage, income, psychological well-being, physical exercise, social engagement, diet and history of chronic diseases [18,19,20,21,22], but some of these findings were controversial, which might be attributable to varied countries of study origin, and the heterogeneity in research methods, including the age range included and the use of different cognitive assessment methods and diagnostic criteria. Early Cognitive Assessment Following Acute Stroke: Feasibility and Comparison between Mini-Mental State Examination and Montreal Cognitive Assessment. They translated scores between the MMSE and MoCA in a geriatric clinic population that was somewhat younger and less educated than our cohort. Ihara M, Aarsland D, Goldstein M, Auribault C, et al Chen T, HL. And several other mmse vs moca specificity features are temporarily unavailable CAMCOG neuropsychological test naming was performed well both. Body mass index on domain-specific cognitive outcomes after stroke scores correlated most for dementia ( PDD ) were. Wuhan, China generally grouped as follows: 25-30 points: normal cognition 3. Chong MS, Tate BA, Stefanik S, Siderowf AD, Duda JE et.: variations in test performance and scores by education in Singapore a Spearman coefficient! 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