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

Persistent Link:
http://hdl.handle.net/10150/221243
Title:
The Montreal Cognitive Assessment and the Mini-Mental State Examination as Screening Instruments for Cognitive Impairment: Item Analyses and Threshold Scores
Author:
Damian, Anne Mariam
Affiliation:
The University of Arizona College of Medicine - Phoenix
Issue Date:
30-Apr-2012
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Collection Information:
This item is part of the College of Medicine - Phoenix Scholarly Projects 2012 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.
Publisher:
The University of Arizona.
Abstract:
Objective: This study was performed to provide a detailed analysis of the MoCA versus the MMSE, including an item analysis and an examination of threshold scores appropriate for use in different clinical settings. Methods: 135 subjects enrolled in a longitudinal clinicopathologic study were administered the MoCA and MMSE. Subjects were classified as cognitively impaired or cognitively normal based on neuropsychological testing and consensus conference diagnosis. Results: 89 subjects were cognitively normal, 46 cognitively impaired (20 dementia, 26 MCI). ROC analysis showed that, for any threshold value selected for the MMSE to identify cognitive impairment, a MoCA value with better sensitivity and specificity could be identified. Recall performed best among individual items on the MMSE, and Orientation performed best on the MoCA. Overall, the best discrimination was obtained using a weighted combination of four items (2*MoCA-Orientation + MMSE-Recall + MoCA-Language + 0.5* MoCA-Visuospatial/Executive; AUC 0.94). A MoCA threshold score of 26 had a sensitivity of 98% and specificity of 52% for identifying cognitive 5 impairment. A MoCA threshold score of 21 had a sensitivity of 57% and specificity of 96%. Conclusions: The MoCA was superior to the MMSE in detecting cognitive impairment. Individual domains on the MoCA and MMSE made substantially different contributions to each instrument’s sensitivity, and a weighted subset of items from both instruments performed best in detecting cognitive impairment. A lower MoCA threshold score may be appropriate in a population with a higher prevalence of cognitive impairment such as a memory clinic.
Keywords:
Cognitive impairment; Montreal Cognitive Assessment
MeSH Subjects:
Mild Cognitive Impairment
Description:
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Mentor:
Jacobson, Sandra, MD

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_US
dc.titleThe Montreal Cognitive Assessment and the Mini-Mental State Examination as Screening Instruments for Cognitive Impairment: Item Analyses and Threshold Scoresen_US
dc.contributor.authorDamian, Anne Mariamen_US
dc.contributor.departmentThe University of Arizona College of Medicine - Phoenixen_US
dc.date.issued2012-04-30-
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.collectioninformationThis item is part of the College of Medicine - Phoenix Scholarly Projects 2012 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.en_US
dc.publisherThe University of Arizona.en_US
dc.description.abstractObjective: This study was performed to provide a detailed analysis of the MoCA versus the MMSE, including an item analysis and an examination of threshold scores appropriate for use in different clinical settings. Methods: 135 subjects enrolled in a longitudinal clinicopathologic study were administered the MoCA and MMSE. Subjects were classified as cognitively impaired or cognitively normal based on neuropsychological testing and consensus conference diagnosis. Results: 89 subjects were cognitively normal, 46 cognitively impaired (20 dementia, 26 MCI). ROC analysis showed that, for any threshold value selected for the MMSE to identify cognitive impairment, a MoCA value with better sensitivity and specificity could be identified. Recall performed best among individual items on the MMSE, and Orientation performed best on the MoCA. Overall, the best discrimination was obtained using a weighted combination of four items (2*MoCA-Orientation + MMSE-Recall + MoCA-Language + 0.5* MoCA-Visuospatial/Executive; AUC 0.94). A MoCA threshold score of 26 had a sensitivity of 98% and specificity of 52% for identifying cognitive 5 impairment. A MoCA threshold score of 21 had a sensitivity of 57% and specificity of 96%. Conclusions: The MoCA was superior to the MMSE in detecting cognitive impairment. Individual domains on the MoCA and MMSE made substantially different contributions to each instrument’s sensitivity, and a weighted subset of items from both instruments performed best in detecting cognitive impairment. A lower MoCA threshold score may be appropriate in a population with a higher prevalence of cognitive impairment such as a memory clinic.en_US
dc.typeThesisen_US
dc.subjectCognitive impairmenten_US
dc.subjectMontreal Cognitive Assessmenten_US
dc.subject.meshMild Cognitive Impairmenten_US
dc.descriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.en_US
dc.contributor.mentorJacobson, Sandra, MDen_US
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