Its poor sensitivity for distinguishing mild cognitive impairment (MCI) is well-described and can be attributed to a lack of complexity as well as the absence of executive function items. One problem with the MMSE is its ceiling effect or limited dynamic performance range for normal individuals, which increases the likelihood that persons in predementia stages score within the normal range (24 and above). The MMSE is also commonly used as a proxy for staging of Alzheimer’s disease (AD). Though there are a number of possible tests, they recommend the Mini-Mental State Examination (MMSE), the most widely used cognitive screening test used by physicians for general cognitive evaluation, and also the newer Montreal Cognitive Assessment (MoCA). 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. Office-based, multi-domain cognitive tests are commonly administered in clinical situations to evaluate patients with cognitive impairment. MoCA scores are translatable to the MMSE to facilitate comparison. Functional assessment can help exclude dementia cases. 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. MoCA and MMSE were more similar for dementia cases, but MoCA distributes MCI cases across a broader score range with less ceiling effect. Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC. The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful. ROC analysis found MoCA ≥ 17 as the cutoff between MCI and dementia that emphasized high sensitivity (92.3 %) to capture MCI cases. Equi-percentile equating showed a MoCA score of 18 was equivalent to MMSE of 24. MoCA and MMSE scores correlated most for dementia ( r = 0.86 versus MCI r = 0.60 HC r = 0.43). The ceiling effect (28–30 points) for MCI and HC was less using MoCA (18.1 %) versus MMSE (71.4 %). Most dementia cases scored abnormally, while MCI and HC score distributions overlapped on each test. Receiver Operating Characteristic (ROC) analyses evaluated lower cutoff scores for capturing the most MCI cases. Equi-percentile equating produced a translation grid for MoCA against MMSE scores. Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI. Stepwise variable selection in logistic regression evaluated relative value of four test domains for separating MCI from HC. Methodsįor 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. Clinicians need to better understand the relationship between MoCA and MMSE scores. Trail making requires cognitive flexibility generated through the dorsolateral and medial prefrontal cortices.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).At the end of the second trial, inform the subject that (s)he will be asked to recall these words again by saying, “ I will ask you to recall those words again at the end of the test.” Try to remember and tell me as many words as you can, including words you said the first time.” Put a check in the allocated space for each word the subject recalls after the second trial. When the subject indicates that (s)he has finished (has recalled all words), or can recall no more words, read the list a second time with the following instructions: “ I am going to read the same list for a second time. It doesn’t matter in what order you say them.” Mark a check in the allocated space for each word the subject produces on this first trial. When I am through, tell me as many words as you can remember. I am going to read a list of words that you will have to remember now and later on. Read a list of 5 words at a rate of 1 word per second, giving the following instructions: “ This is a memory test.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |