scholarly journals Accuracy of the Cognitive Assessment Battery in a Primary Care Population

2019 ◽  
Vol 9 (2) ◽  
pp. 294-301 ◽  
Author(s):  
Anna S. Kvitting ◽  
Maria M. Johansson ◽  
Jan Marcusson
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Characteristic Curve ◽  
Numerical Data ◽  
Assessment Tools ◽  
Binary Outcomes ◽  
Assessment Battery ◽  
Primary Care Population

Background: There are several cognitive assessment tools used in primary care, e.g., the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment. The Cognitive Assessment Battery (CAB) was introduced as a sensitive tool to detect cognitive decline in primary care. However, primary care validation is lacking. Therefore, we investigated the accuracy of the CAB in a primary care population. Objective: To investigate the accuracy of the CAB in a primary care population. Methods: Data from 46 individuals with cognitive impairment and 33 individuals who visited the primary care with somatic noncognitive symptoms were analyzed. They were investigated with the MMSE, the CAB, and a battery of neuropsychological tests; they also underwent consultation with a geriatric specialist. The accuracy of the CAB was assessed using c-statistics and the area under the receiver operating characteristic curve (AUC) was used to quantify the binary outcomes (“no cognitive impairment” or “cognitive impairment”). Results: The “cognitive impairment” group was significantly different from the unimpaired group for all the subtests of the CAB. When accuracy was based on binary significant reduction or not in one or several domains of the CAB, the AUC varied between 0.685 and 0.772. However, when a summation or logistic regression of several subcategories was performed, using the numerical values for each subcategory, the AUC was >0.9. For comparison, the AUC for the MMSE was 0.849. Conclusions: The accuracy of the CAB in a primary care population is poor to good when using binary cutoffs. Accuracy can be improved to high when using a summation or logistic regression of the numerical data of the subcategories. Considering CAB time, lack of adequate age norms, and a good accuracy for the MMSE, implementation of the CAB in primary care is not recommended at present based on the results of this study.

The use of a computerised cognitive assessment to improve the efficiency of primary care referrals to memory services: Protocol for the ADePT study (Preprint)

2021 ◽  
Author(s):  
Chris Kalafatis ◽  
Mohammad Hadi Modarres ◽  
Panos Apostolou ◽  
Naji Tabet ◽  
Seyed-Mahdi Khaligh-Razavi
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Clinical Practice ◽  
Cognitive Assessment ◽  
Assessment Tool ◽  
Economic Benefits ◽  
Assessment Tools ◽  
Remote Memory ◽  
Memory Clinic ◽  
Potential Health

BACKGROUND Existing primary care cognitive assessment tools are crude or time-consuming screening instruments which can only detect cognitive impairment when it is well established. Due to the COVID-19 pandemic, memory services have adapted to the new environment by moving to remote patient assessments to continue meeting service user demand. However, the remote use of cognitive assessments has been variable while there has been scant evaluation of the outcome of such a change in clinical practice. Emerging research in remote memory clinics has highlighted computerised cognitive tests, such as the Integrated Cognitive Assessment (ICA), as a prominent candidate for adoption in clinical practice both during the pandemic and for post-COVID implementation as part of healthcare innovation. OBJECTIVE We initiated the Accelerating Dementia Pathway Technologies (ADePT) study. The intention of conducting this study is to develop a real-world evidence basis to support the adoption of ICA as an inexpensive screening tool for the detection of cognitive impairment and improving the efficiency of the dementia care pathway. METHODS Patients who have been referred to a memory clinic from GPs are recruited. Participants complete the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome are compared with the specialist diagnosis obtained at the memory clinic. The clinical outcomes as well as NHS reference costing data will be used to assess the potential health economic benefits of the use of the ICA in the dementia diagnosis pathway. RESULTS The ADePT study was funded in January 2020 by Innovate UK (Project reference 105837). As of September 2021, 86 participants have been recruited in the study, with 23 participants also completing a retest visit. Initially the study was designed for in person visits at the memory clinic, however in light of the COVID-19 pandemic, the study was amended to allow remote as well as face-to-face visits. The study was also expanded from a single site to 4 sites in the United Kingdom. We expect results to be published by the second quarter of 2022. CONCLUSIONS The ADePT project aims at improving the efficiency of the dementia pathway at its very beginning and supports systems integration at the intersection between primary and secondary care. The introduction of a standardised, self-administered, digital assessment tool for the timely detection of neurodegeneration as part of a decision-support system that can signpost accordingly can reduce unnecessary referrals, reduce service backlog and assessment variability. CLINICALTRIAL ISRCTN Number: 16596456

scholarly journals Utility of the Mini-Cog for Detection of Cognitive Impairment in Primary Care: Data from Two Spanish Studies

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Cristóbal Carnero-Pardo ◽  
Isabel Cruz-Orduña ◽  
Beatriz Espejo-Martínez ◽  
Carolina Martos-Aparicio ◽  
Samuel López-Alcalde ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Characteristic Curve ◽  
Total Sample ◽  
Phase Iii ◽  
Kappa Index ◽  
Two Phase ◽  
Clock Drawing Test ◽  
Pooled Data ◽  
Post Hoc

Objectives. To study the utility of the Mini-Cog test for detection of patients with cognitive impairment (CI) in primary care (PC).Methods. We pooled data from two phase III studies conducted in Spain. Patients with complaints or suspicion of CI were consecutively recruited by PC physicians. The cognitive diagnosis was performed by an expert neurologist, after formal neuropsychological evaluation. The Mini-Cog score was calculatedpost hoc, and its diagnostic utility was evaluated and compared with the utility of the Mini-Mental State (MMS), the Clock Drawing Test (CDT), and the sum of the MMS and the CDT (MMS+CDT) using the area under the receiver operating characteristic curve (AUC). The best cut points were obtained on the basis of diagnostic accuracy (DA) and kappa index.Results. A total sample of 307 subjects (176 CI) was analyzed. The Mini-Cog displayed an AUC (±SE) of0.78±0.02, which was significantly inferior to the AUC of the CDT (0.84±0.02), the MMS (0.84±0.02), and theMMS+CDT(0.86±0.02). The best cut point of the Mini-Cog was 1/2 (sensitivity 0.60, specificity 0.90, DA 0.73, and kappa index0.48±0.05).Conclusions. The utility of the Mini-Cog for detection of CI in PC was very modest, clearly inferior to the MMS or the CDT. These results do not permit recommendation of the Mini-Cog in PC.

Cognitive assessment tools in Asia: a systematic review

2015 ◽  
Vol 28 (2) ◽  
pp. 189-210 ◽  
Author(s):  
Roshaslina Rosli ◽  
Maw Pin Tan ◽  
William Keith Gray ◽  
Pathmawathi Subramanian ◽  
Ai-Vyrn Chin
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
De Novo ◽  
Assessment Tools ◽  
Screening Tools ◽  
Cochrane Library ◽  
Future Research ◽  
Asian Populations ◽  
Keywords Dementia

ABSTRACTBackground:The prevalence of dementia is increasing in Asia than in any other continent. However, the applicability of the existing cognitive assessment tools is limited by differences in educational and cultural factors in this setting. We conducted a systematic review of published studies on cognitive assessments tools in Asia. We aimed to rationalize the results of available studies which evaluated the validity of cognitive tools for the detection of cognitive impairment and to identify the issues surrounding the available cognitive impairment screening tools in Asia.Methods:Five electronic databases (CINAHL, MEDLINE, Embase, Cochrane Library, and Science Direct) were searched using the keywords dementia Or Alzheimer Or cognitive impairment And screen Or measure Or test Or tool Or instrument Or assessment, and 2,381 articles were obtained.Results:Thirty-eight articles, evaluating 28 tools in seven Asian languages, were included. Twenty-nine (76%) of the studies had been conducted in East Asia with only four studies conducted in South Asia and no study from northern, western, or central Asia or Indochina. Local language translations of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed in 15 and six studies respectively. Only three tools (the Korean Dementia Screening Questionnaire, the Picture-based Memory Intelligence Scale, and the revised Hasegawa Dementia Screen) were derivedde novofrom Asian populations. These tools were assessed in five studies. Highly variable cut-offs were reported for the MMSE (17–29/30) and MoCA (21–26/30), with 13/19 (68%) of studies reporting educational bias.Conclusions:Few cognitive assessment tools have been validated in Asia, with no published validation studies for many Asian nations and languages. In addition, many available tools display educational bias. Future research should include concerted efforts to develop culturally appropriate tools with minimal educational bias.

Montreal Cognitive Assessment for Screening Mild Cognitive Impairment: Variations in Test Performance and Scores by Education in Singapore

2015 ◽  
Vol 39 (3-4) ◽  
pp. 176-185 ◽  
Author(s):  
Tze Pin Ng ◽  
Lei Feng ◽  
Wee Shiong Lim ◽  
Mei Sian Chong ◽  
Tih Shih Lee ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Test Performance ◽  
Cognitive Assessment ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Montreal Cognitive Assessment ◽  
Community Based ◽  
Education Group ◽  
And Gender

Background: The Montreal Cognitive Assessment (MoCA) was developed as a screening instrument for mild cognitive impairment (MCI). We evaluated the MoCA's test performance by educational groups among older Singaporean Chinese adults. Method: The MoCA and Mini-Mental State Examination (MMSE) were evaluated in two independent studies (clinic-based sample and community-based sample) of MCI and normal cognition (NC) controls, using receiver operating characteristic curve analyses: area under the curve (AUC), sensitivity (Sn), and specificity (Sp). Results: The MoCA modestly discriminated MCI from NC in both study samples (AUC = 0.63 and 0.65): Sn = 0.64 and Sp = 0.36 at a cut-off of 28/29 in the clinic-based sample, and Sn = 0.65 and Sp = 0.55 at a cut-off of 22/23 in the community-based sample. The MoCA's test performance was least satisfactory in the highest (>6 years) education group: AUC = 0.50 (p = 0.98), Sn = 0.54, and Sp = 0.51 at a cut-off of 27/28. Overall, the MoCA's test performance was not better than that of the MMSE. In multivariate analyses controlling for age and gender, MCI diagnosis was associated with a <1-point decrement in MoCA score (η2 = 0.010), but lower (1-6 years) and no education was associated with a 3- to 5-point decrement (η2 = 0.115 and η2 = 0.162, respectively). Conclusion: The MoCA's ability to discriminate MCI from NC was modest in this Chinese population, because it was far more sensitive to the effect of education than MCI diagnosis.

Screening utility of the Montreal Cognitive Assessment (MoCA): in place of – or as well as – the MMSE?

2011 ◽  
Vol 24 (3) ◽  
pp. 391-396 ◽  
Author(s):  
A. J. Larner
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Characteristic Curve ◽  
The Elderly ◽  
Montreal Cognitive Assessment ◽  
Test Accuracy ◽  
Diagnostic Utility ◽  
Memory Clinic ◽  
Index Study ◽  
In Series

ABSTRACTBackground: This aim of this study was to assess the clinical utility of the Montreal Cognitive Assessment (MoCA) as a screening instrument for cognitive impairment in patients referred to a memory clinic, alone and in combination with the Mini-Mental State Examination (MMSE).Methods: This was a pragmatic prospective study of consecutive referrals attending a memory clinic (n = 150) over an 18-month period. Patients were diagnosed using standard clinical diagnostic criteria for dementia (DSM-IV) and mild cognitive impairment (MCI; cognitive impairment prevalence = 43%) independent of MoCA test scores.Results: MoCA proved acceptable to patients and was quick and easy to use. Using the cut-offs for MoCA and MMSE specified in the index paper (≥26/30), MoCA was more sensitive than MMSE (0.97 vs 0.65) but less specific (0.60 vs 0.89), with better diagnostic accuracy (area under Receiver Operating Characteristic curve 0.91 vs 0.83). Downward adjustment of the MoCA cut-off to ≥20/30 maximized test accuracy and improved specificity (0.95) for some loss of sensitivity (0.63). Combining MoCA with the MMSE – either in series or in parallel – did not improve diagnostic utility above that with either test alone.Conclusions: In a memory clinic population, MoCA proved sensitive for the diagnosis of cognitive impairment. Use of a cut-off lower than that specified in the index study may be required to improve overall test accuracy and specificity for some loss of sensitivity in populations with a high prior probability of cognitive impairment. Combining the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) with the MMSE did not improve diagnostic utility.

scholarly journals Linking the Scores of the Montreal Cognitive Assessment 5-min and the interRAI Cognitive Performance Scale in Older Adults With Mild Physical or Cognitive Impairment

2021 ◽  
Vol 12 ◽  
Author(s):  
Björn Andersson ◽  
Hao Luo ◽  
Gloria H. Y. Wong ◽  
Terry Y. S. Lum
Keyword(s):  
Older Adults ◽  
Hong Kong ◽  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Cognitive Assessment ◽  
Assessment Tools ◽  
Montreal Cognitive Assessment ◽  
Cognitive Performance Scale ◽  
Mild Impairment ◽  
Performance Scale

Background: Bridging scores generated from different cognitive assessment tools is necessary to efficiently track changes in cognition across the continuum of care. This study linked scores from the Montreal Cognitive Assessment-5 min (MoCA 5-min) to the interRAI cognitive Performance Scale (CPS), commonly adopted tools in clinical and long-term care settings, respectively.Methods: We included individual-level data from persons who participated in a home- and community-based care program for older people with mild impairment in Hong Kong. The program used the interRAI-Check Up instrument for needs assessment and service matching between 2017 and 2020. Each participant's cognitive performance was assessed using CPS, CPS Version 2 (CPS2), and MoCA 5-min. We performed equipercentile linking with bivariate log-linear smoothing to establish equivalent scores between the two scales.Results: 3,543 participants had valid data on both scales; 66% were female and their average age was 78.9 years (SD = 8.2). The mean scores for MoCA 5-min, CPS, and CPS2 were 18.5 (SD = 5.9), 0.7 (SD = 0.7), and 1.3 (SD = 1.1), respectively. A CPS or CPS2 score of 0 (intact cognition) corresponds to MoCA 5-min scores of 24 and 25, respectively. At the higher end, a CPS score of 3 (moderately impaired) and a CPS2 score of 5 (moderately impaired Level-2) corresponded to MoCA 5-min scores of 0 and 1, respectively. The linking functions revealed the floor and ceiling effects that exist for the different scales, with CPS and CPS2 measuring more-severe cognitive impairment while the MoCA 5-min was better suited to measure mild impairment.Conclusions: We provided score conversions between MoCA 5-min and CPS/CPS2 within a large cohort of Hong Kong older adults with mild physical or cognitive impairment. This enabled continuity in repeated assessment with different tools and improved comparability of cognitive scores generated from different tools from diverse populations and research cohorts.

scholarly journals A-236 Concurrent Validity of the Paper-Match in a Diverse Population

2020 ◽  
Vol 35 (6) ◽  
pp. 1031-1031
Author(s):  
Veloz C ◽  
Weiss E ◽  
Ayers E ◽  
Possin K ◽  
Verghese J
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
San Francisco ◽  
Health Assessment ◽  
Diverse Population ◽  
Neuropsychological Battery ◽  
Primary Care Population ◽  
Initial Description ◽  
Highly Correlated ◽  
The University

Abstract Introduction Symbol and digit substitution tasks are key instruments in the evaluation of attention, speed of processing, executive functioning, and cognitive dysfunction. The Match is an electronic (app-based) substitution task developed as part of the University of California San Francisco Brain Health Assessment that has been used to demonstrate cognitive impairment. We describe the paper-based oral symbol/number substitution task (Paper-Match), which was developed as part of the 5-Cog battery to assess for cognitive impairment including dementia and demonstrate it’s use in an urban, multi-ethnic, socioeconomically disadvantaged primary care population in Bronx NY. Method 109 participants, mean age 72.61 SD 6.42 and education 11.70 SD 3.82 years, 81% female, 48.6% Hispanic/Latino and 47.7% African American seen as part of 5-Cog. Participants (36.7% tested in Spanish) completed the Paper-Match (scored based on the number of correct matches in 90 seconds) and a comprehensive neuropsychological battery. Descriptive and correlational analysis were conducted. Results Mean Paper-Match score was 38.24 SD 11.83 items correct (range 4–51). Paper-Match performance was highly correlated with performance on the Symbol Digit Modalities Test (r = .819, p &lt; .001) and moderately correlated with performance on the Montreal Cognitive Assessment (MOCA; r = .604, p &lt; .001). Years of education and primary language impacted performances. Conclusion The results of this study provide the initial description and validation of the Paper-Match an oral symbol digit substitution task and its use in a diverse population of older primary care patients. Further research on the psychometric properties and construct validity of the Paper-Match are needed.

scholarly journals Montreal Cognitive Assessment (MoCA) Performance and Domain-Specific Index Scores in Amnestic Versus Aphasic Dementia

2020 ◽  
Vol 26 (9) ◽  
pp. 927-931
Author(s):  
Jessica L. Wood ◽  
Sandra Weintraub ◽  
Christina Coventry ◽  
Jiahui Xu ◽  
Hui Zhang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Multivariate Logistic Regression Analysis ◽  
Primary Progressive Aphasia ◽  
Montreal Cognitive Assessment ◽  
Analysis Of Covariance ◽  
Group Affiliation ◽  
Domain Specific ◽  
Specific Index

ABSTRACTObjective:The Montreal Cognitive Assessment (MoCA) is a popular and simple-to-administer screening instrument to detect cognitive impairment. The MoCA generates a total score and six domain-specific index scores: (1) Memory, (2) Executive Functioning, (3) Attention, (4) Language, (5) Visuospatial, and (6) Orientation. It is unclear whether these MoCA scores can differentiate between distinct clinical dementia syndromes. This study compared MoCA Index scores between amnestic dementia of the Alzheimer’s type (DAT) and primary progressive aphasia (PPA), a language-based dementia.Method:Baseline MoCA data were analyzed from 33 DAT, 37 PPA, and 83 cognitively normal individuals enrolled in the Clinical Core of the Northwestern Alzheimer’s Disease Center. A one-way analysis of covariance adjusted for age was used to compare MoCA scores among groups. A logistic regression model was implemented to observe individual likelihood of group affiliation based on MoCA Index scores.Results:The mean MoCA total score was significantly higher in controls compared to both patient groups (p < .001) but did not differ between DAT and PPA groups. However, in accordance with salient clinical features commonly observed in DAT versus PPA, Memory and Orientation Index scores were lowest in the DAT group (p < .001), whereas Language and Attention Index scores were lowest in the PPA group (p < .001). Multivariate logistic regression analysis showed that the individual effects of Memory (p = .001), Language (p = .002), and Orientation (p = .025) Indices were significant.Conclusions:MoCA Index scores can help differentiate among distinct cognitive syndromes, suggesting it may be a useful brief screening tool to detect domain-specific cognitive impairment.

Sign in / Sign up

Export Citation Format

Share Document