Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults

Paula T Trzepacz; Helen Hochstetler; Shufang Wang; Brett Walker; Andrew J Saykin; Alzheimer’s Disease Neuroimaging Initiative

doi:10.1186/s12877-015-0103-3

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Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults

Journal article

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Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults

Paula T Trzepacz, Helen Hochstetler, Shufang Wang, Brett Walker, Andrew J Saykin and Alzheimer’s Disease Neuroimaging Initiative

BMC geriatrics, Vol.15(1), pp.107-107

09/07/2015

DOI: 10.1186/s12877-015-0103-3

PMCID: PMC4562190

PMID: 26346644

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Abstract

The Montreal Cognitive Assessment (MoCA) was developed to enable earlier detection of mild cognitive impairment (MCI) relative to familiar multi-domain tests like the Mini-Mental State Exam (MMSE). Clinicians need to better understand the relationship between MoCA and MMSE scores. For this cross-sectional study, we analyzed 219 healthy control (HC), 299 MCI, and 100 Alzheimer's disease (AD) dementia cases from the Alzheimer's Disease Neuroimaging Initiative (ADNI)-GO/2 database to evaluate MMSE and MoCA score distributions and select MoCA values to capture early and late MCI cases. Stepwise variable selection in logistic regression evaluated relative value of four test domains for separating MCI from HC. Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI. Equi-percentile equating produced a translation grid for MoCA against MMSE scores. Receiver Operating Characteristic (ROC) analyses evaluated lower cutoff scores for capturing the most MCI cases. Most dementia cases scored abnormally, while MCI and HC score distributions overlapped on each test. Most MCI cases scored ≥ 17 on MoCA (96.3%) and ≥ 24 on MMSE (98.3%). The ceiling effect (28-30 points) for MCI and HC was less using MoCA (18.1%) versus MMSE (71.4%). MoCA and MMSE scores correlated most for dementia (r = 0.86; versus MCI r = 0.60; HC r = 0.43). Equi-percentile equating showed a MoCA score of 18 was equivalent to MMSE of 24. ROC analysis found MoCA ≥ 17 as the cutoff between MCI and dementia that emphasized high sensitivity (92.3%) to capture MCI cases. The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful. Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC. MoCA and MMSE were more similar for dementia cases, but MoCA distributes MCI cases across a broader score range with less ceiling effect. 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. Functional assessment can help exclude dementia cases. MoCA scores are translatable to the MMSE to facilitate comparison.

Quebec - epidemiology

Cross-Sectional Studies

Dementia - psychology

Humans

Middle Aged

Neuropsychological Tests - standards

Dementia - diagnosis

Male

Cognition

Dementia - epidemiology

Alzheimer Disease - diagnosis

Cognitive Dysfunction - epidemiology

Aged, 80 and over

Cognitive Dysfunction - psychology

Alzheimer Disease - epidemiology

Female

Aged

Cognitive Dysfunction - diagnosis

Mental Status Schedule - standards

Alzheimer Disease - psychology

Details

Title: Subtitle: Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults
Creators: Paula T Trzepacz - Indiana University School of Medicine, Indianapolis, IN, USA. pttrzepacz@outlook.com
Helen Hochstetler - Eli Lilly and Company or one of its subsidiaries, Lilly Corporate Center, Indianapolis, IN, USA. hochstetler_helen_m@lilly.com
Shufang Wang - Eli Lilly and Company or one of its subsidiaries, Lilly Corporate Center, Indianapolis, IN, USA. wang_shufang@lilly.com
Brett Walker - University College of London, Gower Street, London, UK. brett.walker.14@ucl.ac.uk
Andrew J Saykin - Indiana University School of Medicine, Indianapolis, IN, USA. asaykin@iupui.edu
Alzheimer’s Disease Neuroimaging Initiative
Contributors: Laura L Boles-Ponto (Contributor) - University of Iowa, Radiology
Resource Type: Journal article
Publication Details: BMC geriatrics, Vol.15(1), pp.107-107
DOI: 10.1186/s12877-015-0103-3
PMID: 26346644
PMCID: PMC4562190
NLM abbreviation: BMC Geriatr
ISSN: 1471-2318
eISSN: 1471-2318
Publisher: England
Grant note: P30 AG010133 / NIA NIH HHS P50 AG005134 / NIA NIH HHS R01 AG019771 / NIA NIH HHS UL1 TR001108 / NCATS NIH HHS R01 LM011360 / NLM NIH HHS CIHR P30 AG10133 / NIA NIH HHS P30 AG013846 / NIA NIH HHS U01 AG024904 / NIA NIH HHS R01 AG19771 / NIA NIH HHS
Language: English
Date published: 09/07/2015
Academic Unit: Radiology; Pharmaceutical Sciences and Experimental Therapeutics
Record Identifier: 9984051596102771

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