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The Montreal Cognitive Assessment is superior to the Mini–Mental State Examination in detecting patients at higher risk of dementia

Published online by Cambridge University Press:  12 June 2012

YanHong Dong ,
Wah Yean Lee ,
Nur Adilah Basri ,
Simon Lowes Collinson ,
Reshma A. Merchant ,
Narayanaswamy Venketasubramanian  and
Christopher Li-Hsian Chen
YanHong Dong
Affiliation:
Department of Pharmacology, National University Health System, Clinical Research Centre, Singapore School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
Wah Yean Lee
Affiliation:
Department of Pharmacology, National University Health System, Clinical Research Centre, Singapore
Nur Adilah Basri
Affiliation:
Department of Pharmacology, National University Health System, Clinical Research Centre, Singapore
Simon Lowes Collinson
Affiliation:
Department of Psychology, National University of Singapore, Singapore
Reshma A. Merchant
Affiliation:
Department of Medicine, National University Health System, Singapore
Narayanaswamy Venketasubramanian
Affiliation:
Department of Medicine, National University Health System, Singapore
Christopher Li-Hsian Chen*
Affiliation:
Department of Pharmacology, National University Health System, Clinical Research Centre, Singapore
*
Correspondence should be addressed to: Dr Christopher Li-Hsian Chen, Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Clinical Research Centre, MD11, Level 5, #05-9, 10 Medical Drive, Singapore 117597, Singapore. Phone: +65 65165885; Fax: +65 68724101. Email: phccclh@nus.edu.sg.
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Abstract

Background: To examine the discriminant validity of the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) in detecting patients with cognitive impairment at higher risk for dementia at a memory clinic setting.

Methods: Memory clinic patients were administered the MoCA, MMSE, and a comprehensive formal neuropsychological battery. Mild cognitive impairment (MCI) subtypes were dichotomized into two groups: single domain–MCI (sd–MCI) and multiple domain-MCI (md–MCI). Area under the receiver operating characteristic curve (ROC) analysis was used to compare the discriminatory ability of the MoCA and the MMSE.

Results: Two hundred thirty patients were recruited, of which 136 (59.1%) were diagnosed with dementia, 61 (26.5%) with MCI, and 33 (14.3%) with no cognitive impairment (NCI). The majority of MCI patients had md–MCI (n = 36, 59%). The MoCA had significantly larger AUCs than the MMSE in discriminating md–MCI from the lower risk group for incident dementia (NCI and sd–MCI) [MoCA 0.92 (95% CI, 0.86–0.98) vs. MMSE 0.84 (95% CI, 0.75–0.92), p = 0.02). At their optimal cut-off points, the MoCA (19/20) remained superior to the MMSE (23/24) in detecting md–MCI [sensitivity: 0.83 vs. 0.72; specificity: 0.86 vs. 0.83; PPV: 0.79 vs. 0.72; NPV: 0.89 vs. 0.83; correctly classified: 85.1% vs. 78.7%].

Conclusion: The MoCA is superior to the MMSE in the detection of patients with cognitive impairment at higher risk for incident dementia at a memory clinic setting.

Keywords

mild cognitive impairmentmemory clinicsscreening
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 11 , November 2012 , pp. 1749 - 1755
Copyright
Copyright © International Psychogeriatric Association 2012

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