scholarly journals The Montreal Cognitive Assessment (MoCA) with a double threshold: improving the MoCA for triaging patients in need of a neuropsychological assessment.

2021 ◽  
pp. 1-13
Author(s):  
Géraud M. F. C. Dautzenberg ◽  
Jeroen G. Lijmer ◽  
Aartjan T. F. Beekman
Keyword(s):  
Neuropsychological Assessment ◽  
Cognitive Assessment ◽  
Selection Process ◽  
High Sensitivity ◽  
Montreal Cognitive Assessment ◽  
Initial Assessment ◽  
Clinical Value ◽  
Active Monitoring ◽  
Increased Risk ◽  
Double Threshold

ABSTRACT Objectives: Diagnosis of patients suspected of mild dementia (MD) is a challenge and patient numbers continue to rise. A short test triaging patients in need of a neuropsychological assessment (NPA) is welcome. The Montreal cognitive assessment (MoCA) has high sensitivity at the original cutoff <26 for MD, but results in too many false-positive (FP) referrals in clinical practice (low specificity). A cutoff that finds all patients at high risk of MD without referring to many patients not (yet) in need of an NPA is needed. A difficulty is who is to be considered at risk, as definitions for disease (e.g. MD) do not always define health at the same time and thereby create subthreshold disorders. Design: In this study, we compared different selection strategies to efficiently identify patients in need of an NPA. Using the MoCA with a double threshold tackles the dilemma of increasing the specificity without decreasing the sensitivity and creates the opportunity to distinguish the clinical (MD) and subclinical (MCI) state and hence to get their appropriate policy. Setting/participants: Patients referred to old-age psychiatry suspected of cognitive impairment that could benefit from an NPA (n = 693). Results: The optimal strategy was a two-stage selection process using the MoCA with a double threshold as an add-on after initial assessment. By selecting who is likely to have dementia and should be assessed further (MoCA<21), who should be discharged (≥26), and who’s course should be monitored actively as they are at increased risk (21<26). Conclusion: By using two cutoffs, the clinical value of the MoCA improved for triaging. A double-threshold MoCA not only gave the best results; accuracy, PPV, NPV, and reducing FP referrals by 65%, still correctly triaging most MD patients. It also identified most MCIs whose intermediate state justifies active monitoring.

scholarly journals 333 - The advantages of a double threshold MoCA (Montreal Cognitive Assessment) for triaging patients to a memory clinic

2020 ◽  
Vol 32 (S1) ◽  
pp. 92-92
Author(s):  
Géraud Dautzenberg ◽  
Jeroen Lijmer ◽  
Aartjan T.F. Beekman
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Screening Tool ◽  
High Sensitivity ◽  
Clinical Aspects ◽  
False Negatives ◽  
Active Monitoring ◽  
Uncertainty Interval ◽  
Classification Errors ◽  
Double Threshold

The MoCA was developed as a screening tool for mild cognitive impairment (MCI) and mild dementia (MD) and validated in different settings. At the original suggested cutoff of <26, with 30 being flawless, it has a high sensitivity for detecting MCI and MD. The specificity is argued in clinical practice. Its high sensitivity makes it a good screener for identifying most MD-patients, however, for selecting those in need of a scarce neuropsychological assessment (NPA), the moderate specificity gives too many false positives. It is repeatedly suggested to lower the cut-off to <21, resulting in higher specificity for identifying MD. But lowering the cut-off, increasing the false negatives, will not decrease the number of classification errors. One needs to triage with a cut-off that finds all patients at high risk of MD without referring too many who are not (yet) in need of a NPA. A difficulty is who to consider at risk, as definitions for illnesses (e.g. MD) do not always define health at the same time and thereby create subthreshold disorders. As MCI is a state of subthreshold dementia -of which 40% worsens 40% stabilizes 20% recovers, therefore justifying its own policy -it is essential to differentiate it from MD and no-cognitive impairment (NoCI). Double thresholds are a solution by using one threshold for health and one for illness. Especially where classifications create subthreshold disorders, regardless of whether these are disorders in their own right or are merely (minor) forms of major disorders. A double threshold MoCA gives the best accuracy and raises the opportunity to differentiate the clinical and subclinical states to their appropriate domain and hence their appropriate policy. Next to these clinical aspects, shown in our study, a double threshold also reduces random classification errors. By applying an uncertainty interval -most errors appear from 21 to 26- the PPV and NPV improves and becomes less dependent of the prevalence. Two thresholds, with <21 selecting patients for NPA and ?26 for clearing patients, gives the best results and achieves two aims at once. It also identifies most MCI (21<26) who’s intermediate state justifies active monitoring.

scholarly journals The items in the Chinese version of the Montreal Cognitive Assessment Basic discriminate among different severities of Alzheimer’s disease

2019 ◽  
Author(s):  
Yan-rong Zhang ◽  
Yun-Long Ding ◽  
Ke-liang Chen ◽  
Yan Liu ◽  
Can Wei ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Sensitivity And Specificity ◽  
Cognitive Assessment ◽  
High Sensitivity ◽  
Chinese Version ◽  
Montreal Cognitive Assessment ◽  
Recall Memory ◽  
Item Scores ◽  
Severity Of Dementia

Abstract Background To determine whether items of the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) could discriminate among cognitively normal controls (NC), and those with mild cognitive impairment (MCI), mild Alzheimer’s disease (AD), and moderate-severe (AD), as well as their sensitivity and specificity.Methods MCI (n=456), mild AD (n=502) and moderate-severe AD (n=102) patients were recruited from the memory clinic, Huashan Hospital, Shanghai, China. NC (n=329) were recruited from health checkup outpatients. Five MoCA-BC item scores were collected in interviews.Results The MoCA-BC orientation test had high sensitivity and specificity for discrimination among MCI, mild AD and moderate-severe AD. The delayed recall memory test had high sensitivity and specificity for MCI screening. The verbal fluency test was efficient for detecting MCI and differentiating AD severity.Conclusions Various items of the MoCA-BC can identify MCI patients early and identify the severity of dementia.

scholarly journals The items in the Chinese version of the Montreal Cognitive Assessment Basic discriminate among different severities of Alzheimer’s disease

2019 ◽  
Author(s):  
Yan-rong Zhang ◽  
Yun-Long Ding ◽  
Ke-liang Chen ◽  
Yan Liu ◽  
Can Wei ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Sensitivity And Specificity ◽  
Cognitive Assessment ◽  
High Sensitivity ◽  
Chinese Version ◽  
Montreal Cognitive Assessment ◽  
Recall Memory ◽  
Item Scores ◽  
Severity Of Dementia

Abstract Background To determine whether items of the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) could discriminate among cognitively normal controls (NC), and those with mild cognitive impairment (MCI), mild Alzheimer’s disease (AD), and moderate-severe (AD). Methods MCI (n=456), mild AD (n=502) and moderate-severe AD (n=102) patients were recruited from the memory clinic, Huashan Hospital, Shanghai, China. NC (n=329) were recruited from health checkup outpatients. Five MoCA-BC item scores were collected in interviews. Results The MoCA-BC orientation test had high sensitivity and specificity for discrimination among MCI, mild AD and moderate-severe AD. The delay recall memory test had high sensitivity and specificity for MCI screening. The verbal fluency test was efficient for detecting MCI and differentiating AD severity. Conclusions Various items of the MoCA-BC can identify MCI patients early and identify the severity of dementia.

scholarly journals Comparative assessment of Montreal Cognitive Assessment (MOCA) and Minimental State Examination (MMSE) in apolipoprotein E (APOE) ɛ4 allele carriers in epilepsy

2016 ◽  
Vol 03 (01) ◽  
pp. 007-011 ◽  
Author(s):  
Amirthalingam Palanisamy ◽  
Natham Rajendran ◽  
Mukundhu Narmadha ◽  
Ruckmani Ganesvaran
Keyword(s):  
Cognitive Impairment ◽  
Apolipoprotein E ◽  
Cognitive Assessment ◽  
High Sensitivity ◽  
Educational Status ◽  
Cognitive Status ◽  
Montreal Cognitive Assessment ◽  
Normal Cognitive Function ◽  
E4 Allele ◽  
State Examination

AbstractBackground/Aim Mini mental state examination (MMSE) is a widely accepted tool till date to investigate cognitive status; however, its sensitivity is questioned by few studies. Alternately, Montreal cognitive assessment (MOCA) is considered more effective with high sensitivity to assess cognitive status than MMSE. The usefulness of MOCA is well established in assessing cognitive status in patients in various disorders. Apolipoprotein E (APOE) ɛ4 allele is identified as one of the risk factors associated with cognitive impairment on MMSE; however, the usefulness of MOCA on the association between APOE ɛ4 allele and cognitive impairment is not clearly established and hence the present study.Methods This prospective study recruited 123 subjects diagnosed as tonic-clonic seizures in the study site during the study period.Results Gender and educational status showed normal cognitive function on MMSE but showed cognitive impairment on MOCA. Among epilepsy patients, all APOE ɛ4 carriers showed mild to severe cognitive impairment on MOCA but differences in cognitive status were observed in this population as well as in APOE ɛ4 non-carriers on MMSE.Conclusion Thus, the present study demonstrates the sensitivity of MOCA over MMSE in detecting cognitive impairment in epilepsy.

The reliability of the Montreal Cognitive Assessment using telehealth in a rural setting with veterans

2018 ◽  
Vol 25 (4) ◽  
pp. 197-203 ◽  
Author(s):  
Nathaniel DeYoung ◽  
Brian V Shenal
Keyword(s):  
Neuropsychological Assessment ◽  
Rural Areas ◽  
Cognitive Assessment ◽  
Good Accuracy ◽  
Reliability And Validity ◽  
Montreal Cognitive Assessment ◽  
Rural Setting ◽  
Neurocognitive Dysfunction ◽  
Assessment Scores ◽  
Mean Differences

Background Telehealth neuropsychological services can increase the availability of specialised care for individuals in rural areas where barriers to these services are faced. As this practice becomes more commonplace, the reliability and validity of neuropsychological assessment administered by telehealth continues to be established. The Montreal Cognitive Assessment, a screener for general neurocognitive dysfunction, may be particularly useful since this measure can be given by telehealth with minimal adaptation. Methods Veterans from a rural area of the country who were referred to an outpatient neuropsychology clinic were administered the Montreal Cognitive Assessment either in-person or by telehealth by a clinician. A second clinician observed the administration in-person or by telehealth and independently scored the each participant’s performance. The inter-rater reliabilities across conditions were compared to assess for differences between in-person and telehealth consultations. Results The inter-rater reliability of the Montreal Cognitive Assessment across the three conditions of interest was acceptably high and values ranged from r = 0.88 to r = 0.98. Reliability correlations were compared and no significant differences among the conditions were observed ( p’s > 0.10). Beyond reliability, univariate comparison of the absolute mean differences of clinician scores showed no significant differences among the actual raw scores of the three conditions tested, indicating good accuracy ( p = 0.56). Conclusions The inter-rater reliabilities of Montreal Cognitive Assessment scores across conditions were all acceptably high, and administration of the Montreal Cognitive Assessment using telehealth technology did not significantly alter the total scores. Overall, the lack of significant differences suggests that administering the Montreal Cognitive Assessment by telehealth is reliable, accurate and well received by participants.

scholarly journals The items in the Chinese version of the Montreal Cognitive Assessment Basic discriminate among different severities of Alzheimer’s disease

2019 ◽  
Author(s):  
Yan-rong Zhang ◽  
Yun-Long Ding ◽  
Ke-liang Chen ◽  
Yan Liu ◽  
Can Wei ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Sensitivity And Specificity ◽  
Cognitive Assessment ◽  
High Sensitivity ◽  
Chinese Version ◽  
Montreal Cognitive Assessment ◽  
Recall Memory ◽  
Item Scores ◽  
Severity Of Dementia

Abstract Background To determine whether items of the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) could discriminate among cognitively normal controls (NC), and those with mild cognitive impairment (MCI), mild Alzheimer’s disease (AD), and moderate-severe (AD), as well as their sensitivity and specificity.Methods MCI (n=456), mild AD (n=502) and moderate-severe AD (n=102) patients were recruited from the memory clinic, Huashan Hospital, Shanghai, China. NC (n=329) were recruited from health checkup outpatients. Five MoCA-BC item scores were collected in interviews.Results The MoCA-BC orientation test had high sensitivity and specificity for discrimination among MCI, mild AD and moderate-severe AD. The delayed recall memory test had high sensitivity and specificity for MCI screening. The verbal fluency test was efficient for detecting MCI and differentiating AD severity.Conclusions Various items of the MoCA-BC can identify MCI patients early and identify the severity of dementia.

scholarly journals Chronic migraine patients show cognitive impairment in an extended neuropsychological assessment

2018 ◽  
Vol 76 (9) ◽  
pp. 582-587 ◽  
Author(s):  
Karen S. Ferreira ◽  
Caroliny T. Teixeira ◽  
Carolina Cáfaro ◽  
Gabriela Z. Oliver ◽  
Gabriela L. P. Carvalho ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Neuropsychological Assessment ◽  
Cognitive Deficits ◽  
Cognitive Assessment ◽  
Verbal Fluency ◽  
Digit Span ◽  
Cognitive Disorders ◽  
Montreal Cognitive Assessment ◽  
Clock Drawing ◽  
Statistical Adjustment

ABSTRACT The objective of the present study was to assess the presence of cognitive deficits in patients with chronic migraine, and to assess the main factors that trigger cognitive disorders, such as comorbidities or the use of medications. Methods: Chronic migraine and control groups were interviewed in a case-control study. The frequency and intensity of the headache, medication used and associated comorbidities were determined. All patients were submitted to an extended neuropsychological assessment. Results: The chronic migraine group (n = 30) had a worse performance in the Montreal Cognitive Assessment Test (p = 0.00), Verbal Fluency (p = 0.00), Stroop (p = 0.00), Clock Drawing Test (p = 0.00), Digit Span (p = 0.00) and Matrix Reasoning (p = 0.01). After statistical adjustment by linear regression, migraine continued to be the only relevant factor in the poorer performance in the Montreal Cognitive Assessment, Verbal Fluency, Clock Drawing and Stroop tests. Conclusion: Patients with chronic migraine have cognitive deficits in multiple tasks, regardless of the presence of comorbidities or the use of medications.

scholarly journals The items in the Chinese version of the Montreal cognitive assessment basic discriminate among different severities of Alzheimer’s disease

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yan-Rong Zhang ◽  
Yun-Long Ding ◽  
Ke-liang Chen ◽  
Yan Liu ◽  
Can Wei ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Sensitivity And Specificity ◽  
Cognitive Assessment ◽  
High Sensitivity ◽  
Chinese Version ◽  
Montreal Cognitive Assessment ◽  
Recall Memory ◽  
Item Scores ◽  
Severity Of Dementia

Abstract Background To determine whether items of the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) could discriminate among cognitively normal controls (NC), and those with mild cognitive impairment (MCI), mild Alzheimer’s disease (AD), and moderate-severe (AD), as well as their sensitivity and specificity. Methods MCI (n = 456), mild AD (n = 502) and moderate-severe AD (n = 102) patients were recruited from the memory clinic, Huashan Hospital, Shanghai, China. NC (n = 329) were recruited from health checkup outpatients. Five MoCA-BC item scores were collected in interviews. Results The MoCA-BC orientation test had high sensitivity and specificity for discrimination among MCI, mild AD and moderate-severe AD. The delayed recall memory test had high sensitivity and specificity for MCI screening. The verbal fluency test was efficient for detecting MCI and differentiating AD severity. Conclusions Various items of the MoCA-BC can identify MCI patients early and identify the severity of dementia.

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