Validation of the Montreal Cognitive Assessment (MoCA) in Spanish as a screening tool for mild cognitive impairment and mild dementia in patients over 65 years old in Bogotá, Colombia

Validation of the Czech Montreal Cognitive Assessment for Mild Cognitive Impairment due to Alzheimer Disease and Czech Norms in 1,552 Elderly Persons

BACKGROUND

The Czech version of the Montreal Cognitive Assessment (MoCA-CZ) and delayed recall of 5 words have not been validated in patients with mild cognitive impairment (MCI) due to Alzheimer disease (AD) and compared to norms of a large population.

METHOD

The MoCA-CZ was administered to 1,600 elderly individuals in 2 groups consisting of 48 patients with MCI due to AD (AD-MCI) and 1,552 normal elderly adults.

RESULTS

MoCA-CZ scores were significantly lower in the AD-MCI patients than in the normal elderly (21 ± 4 vs. 26 ± 3 points; p = 0.03). Under the recommended cutoff score of ≤25, the MoCA-CZ demonstrated an excellent sensitivity of 94% but a low specificity of 62%. When the score was reduced to ≤24, the MoCA-CZ showed an optimal sensitivity of 87% for AD-MCI and a specificity of 72%. Normal elderly persons should recall at least 2 words after delay (sensitivity 80%, specificity 74%). Several cutoff points were derived from normative data stratified by age and education.

CONCLUSIONS

The cutoff for AD-MCI and stratified norms are available for the MoCA total score and delayed recall of the Czech version. The cut-off scores of the MoCA-CZ, sensitivity, and specificity are lower than in the original study.

Resting functional connectivity and mild cognitive impairment in Parkinson’s disease. An electroencephalogram study

Objective: Parkinson’s disease (PD) is characterized by cognitive deficits. There is not clarity about electroencephalogram (EEG) connectivity related to the cognitive profile of patients. Our objective was to evaluate connectivity over resting EEG in nondemented PD. Methods: PD subjects with and without mild cognitive impairment (MCI) were assessed using coherence from resting EEG for local, intra and interhemispheric connectivity. Results: PD subjects without MCI (PD-nMCI) had lower intra and interhemispheric coherence in alpha2 compared with controls. PD with MCI (PD-MCI) showed higher intra and posterior interhemispheric coherence in alpha2 and beta1, respectively, in comparison to PD-nMCI. PD-MCI presented lower frontal coherence in beta frequencies compared with PD-nMCI. Conclusion: EEG coherence measures indicate distinct cortical activity in PD with and without MCI.

Cross-cultural adaptation and psychometric properties of the MMSE and MoCA questionnaires in Tanzanian Swahili for a traumatic brain injury population

BACKGROUND

Traumatic Brain Injury (TBI) is the most common cause of injury-related death and disability globally, and a common sequelae is cognitive impairment. Addressing post-TBI cognitive deficits is crucial because they affect rehabilitation outcomes, but doing this requires valid and reliable cognitive assessment measures. However, no such instrument has been validated in Tanzania's TBI population. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are two commonly used instruments to measure cognitive impairment, and there have been a few studies reporting their use in post-TBI cognitive assessment. Our aim was to report the psychometric properties of the Swahili version of both scales amongst the TBI population in Tanzania.

METHODS

A cross-cultural adaptation committee participated in the translation and content validation process for both questionnaires. Our patient sample consisted of 192 adults with TBI who were admitted to Kilimanjaro Christian Medical Center (KCMC) in Tanzania. Confirmatory factor analysis, reliability and external validity were evaluated.

RESULTS

MoCA showed adequate factor loadings (values > 0.50 for all items except items 7 & 10) and adequate reliability (values > 0.70). Factor loadings for most of the MMSE items were below 0.5 and internal consistency was medium (< 0.7). Polychoric correlation between MMSE and MoCA was strong, positive and statistically significant (r = 0.68, p = 0.001); correlation with the cognitive subscale of FIM indicated moderately positive relationships - MMSE (r = 0.35, p = 0.001) and MoCA (r = 0.43, p = 0.001).

CONCLUSIONS

With the exception of the language and memory items, MoCA is a valid and reliable instrument for cognitive impairment screening in Tanzania's adult TBI population. On the other hand, MMSE does not appear to be an appropriate tool in this patient group, but its positive correlations with MoCA and cFIM indicate similar theoretical concepts. Both instruments require further validation studies to prove their predictive ability for screening cognitive impairment before they are considered suitable for clinical use.

Differential Methylation in APOE (Chr19; Exon Four; from 44,909,188 to 44,909,373/hg38) and Increased Apolipoprotein E Plasma Levels in Subjects with Mild Cognitive Impairment

BACKGROUND

Biomarkers are essential for identification of individuals at high risk of mild cognitive impairment (MCI) for potential prevention of dementia. We investigated DNA methylation in the APOE gene and apolipoprotein E (ApoE) plasma levels as MCI biomarkers in Colombian subjects with MCI and controls.

METHODS

In total, 100 participants were included (71% women; average age, 70 years; range, 43⁻91 years). MCI was diagnosed by neuropsychological testing, medical and social history, activities of daily living, cognitive symptoms and neuroimaging. Using multivariate logistic regression models adjusted by age and gender, we examined the risk association of MCI with plasma ApoE and APOE methylation.

RESULTS

MCI was diagnosed in 41 subjects (average age, 66.5 ± 9.6 years) and compared with 59 controls. Elevated plasma ApoE and APOE methylation of CpGs 165, 190, and 198 were risk factors for MCI (p < 0.05). Higher CpG-227 methylation correlated with lower risk for MCI (p = 0.002). Only CpG-227 was significantly correlated with plasma ApoE levels (correlation coefficient = -0.665; p = 0.008).

CONCLUSION

Differential APOE methylation and increased plasma ApoE levels were correlated with MCI. These epigenetic patterns require confirmation in larger samples but could potentially be used as biomarkers to identify early stages of MCI.

Validity and reliability of the Persian version of the Montreal Cognitive Assessment (MoCA-P) scale among subjects with Parkinson's disease

Parkinson's disease (PD) is a progressive multifactorial degenerative disorder that has both motor and nonmotor features. Among the nonmotor features of PD, cognitive impairment; Mild Cognitive Impairment (MCI) and dementia, poses one of the most significant implications for disability. Because of the high possibility of developing Dementia in PD, it is essential to obtain a reliable cognitive screen. Two commonly used cognitive measures include the Mini Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The MoCA is a more sensitive tool for the detection of MCI in compared to the MMSE. Because of the cultural differences, in this study, we evaluated the psychometric properties of the Persian version of the MoCA (MoCA-P) in a group of participants with PD in Iran. Participants were assessed by MMSE, Geriatric Depression Scale (GDS), and Functional Assessment Staging Test (FAST). If they met study eligibility, the MoCA-P scale was administered. Receiver Operating Characteristic (ROC) curve analyses showed that the MoCA-P scale produced significant discrimination of PD with Dementia (PDD) from PD with MCI (PD-MCI). It seems that the MoCA-P has adequate psychometric properties as a screening instrument for the detection of PD-MCI and PDD in Iranian patients. As near to 30% of patients with PD go on to develop dementia, the MoCA-P can be useful in the detection of cognitive impairment in patients with PD and is suitable for executive function assessment.

Estimation of diagnostic performance of dementia screening tests: Mini-Mental State Examination, Mini-Cog, Clock Drawing test and Ascertain Dementia 8 questionnaire

OBJECTIVE

Dementia is one of the leading causes of dependence in the elderly. This study was conducted to estimate diagnostic performance of dementia screening tests including Mini-Mental State Examination (MMSE), Mini-Cog, Clock Drawing Test (CDT) and Ascertain Dementia 8 questionnaire (AD8) by Bayesian models.

METHOD

A total of 2015 participants aged 65 years or more in eastern China were enrolled. The four screening tests were administered and scored by specifically trained psychiatrists. The prior information of sensitivity and specificity of every screening test was updated via Bayes' theorem to a posterior distribution. Then the results were compared with the estimation based on National Institute of Aging-Alzheimer's Association criteria (NIA-AA).

RESULTS

The diagnostic characteristics of Mini-Cog, including sensitivity, specificity, PPV, NPV, especially the Youden index, performed well, even better than the combinations of several screening tests.

CONCLUSION

The Mini-Cog with excellent screening characteristics, spending less time, could be considered to be used as a screening test to help to screen patients with cognitive impairment or dementia early. And Bayesian method was shown to be a suitable tool for evaluating dementia screening tests.

CONCLUSION

The Mini-Cog with excellent screening characteristics, spending less time, could be considered to be used as a screening test to help to screen patients with cognitive impairment or dementia early. And Bayesian method was shown to be a suitable tool for evaluating dementia screening tests.

Functional Connectivity Changes in Behavioral, Semantic, and Nonfluent Variants of Frontotemporal Dementia

Frontotemporal dementia (FTD) affects behavior, language, and personality. This study aims to explore functional connectivity changes in three FTD variants: behavioral (bvFTD), semantic (svPPA), and nonfluent variant (nfvPPA). Seventy-six patients diagnosed with FTD by international criteria and thirty-two controls were investigated. Functional connectivity from resting functional magnetic resonance imaging (fMRI) was estimated for the whole brain. Two types of analysis were done: network basic statistic and topological measures by graph theory. Several hubs in the limbic system and basal ganglia were compromised in the behavioral variant apart from frontal networks. Nonfluent variants showed a major disconnection with respect to the behavioral variant in operculum and parietal inferior. The global efficiency had lower coefficients in nonfluent variants than behavioral variants and controls. Our results support an extensive disconnection among frontal, limbic, basal ganglia, and parietal hubs.

Cross-Cultural Applicability of the Montreal Cognitive Assessment (MoCA): A Systematic Review

The Montreal Cognitive Assessment (MoCA) is widely used to screen for mild cognitive impairment (MCI). While there are many available versions, the cross-cultural validity of the assessment has not been explored sufficiently. We aimed to interrogate the validity of the MoCA in a cross-cultural context: in differentiating MCI from normal controls (NC); and identifying cut-offs and adjustments for age and education where possible. This review sourced a wide range of studies including case-control studies. In addition, we report findings for differentiating dementias from NC and MCI from dementias, however, these were not considered to be an appropriate use of the MoCA. The subject of the review assumes heterogeneity and therefore meta-analyses was not conducted. Quality ratings, forest plots of validated studies (sensitivity and specificity) with covariates (suggested cut-offs, age, education and country), and summary receiver operating characteristic curve are presented. The results showed a wide range in suggested cutoffs for MCI cross-culturally, with variability in levels of sensitivity and specificity ranging from low to high. Poor methodological rigor appears to have affected reported accuracy and validity of the MoCA. The review highlights the necessity for cross-cultural considerations when using the MoCA, and recognizing it as a screen and not a diagnostic tool. Appropriate cutoffs and point adjustments for education are suggested.

Italians do it worse. Montreal Cognitive Assessment (MoCA) optimal cut-off scores for people with probable Alzheimer's disease and with probable cognitive impairment

Montreal cognitive assessment (MoCA) is a test providing a brief screening for people with cognitive impairment due to aging or neurodegenerative syndromes. In Italy, as in the rest of the world, several validation studies of MoCA have been carried out. This study compared, for the first time in Italy, a sample of people with probable Alzheimer's Disease (AD) with healthy counterparts. The study also compared two community-dwelling groups of aged participants with and without probable cognitive impairment, as discriminated by two cut-off points of adjusted MMSE score. All the comparisons were carried out according to ROC statistics. Optimal cutoff for a diagnosis of probable AD was a MoCA score ≤14. Optimal cutoff for the discrimination of probable cognitive impairment was a MoCA score ≤17 (associated to MMSE cutoff of 23.8). Results confirm the substantial discrepancy in cut-off points existing between Italian and other international validation studies, showing that Italian performance on MoCA seems to be globally lower than that in other Countries. Characteristics of population might explain these results.

Montreal Cognitive Assessment and Mini-Mental State Examination reliable change indices in healthy older adults

OBJECTIVE

Cognitive tests are used repeatedly to assess the treatment response or progression of cognitive disorders. The Montreal Cognitive Assessment (MoCA) is a valid screening test for mild cognitive impairment. The aim of our study was to establish 90% reliable change indices (RCI) for the MoCA together with the Mini-Mental State Examination (MMSE) in cognitively healthy older adults.

METHOD

We analyzed 197 cognitively healthy and functional independent volunteers aged 60-94 years, who met strict inclusion criteria for four consecutive years. The RCI methods by Chelune and Hsu were used.

RESULTS

For 1, 2, and 3 years, the 90% RCI for MoCA using Chelune's formula were -4 ≤, ≥4; -4 ≤, ≥4 and -5 ≤, ≥4 points, respectively, and -3 ≤, ≥3 for the MMSE each year. Ninety percent RCI for MoCA using Hsu's formula ranged from -6 to 0, respectively, and +3 to +8 dependent on the baseline MoCA.

CONCLUSION

Our study demonstrated RCI for the MoCA and MMSE in a 3-year time period that can be used for the estimation of cognitive decline or improvement in clinical settings. Copyright © 2016 John Wiley & Sons, Ltd.

Validity and Reliability of the Spanish Version of the Montreal Cognitive Assessment (MoCA) for the Detection of Cognitive Impairment in Mexico

OBJECTIVE

To establish the validity and reliability of the Montreal Cognitive Assessment in Spanish (MoCA-S) to identify mild cognitive impairment (MCI) and dementia in the Mexican elderly population.

MATERIAL AND METHODS

168 participants from a memory clinic in Mexico City were enrolled and divided into 3 groups: 59 cognitively healthy (CHG), 52 with mild cognitive impairment (MCI) (DSM-5 criteria) and 57 with dementia (NINCDS-ADRDA criteria). The MoCA-S and Mini-Mental State Evaluation (MMSE) were applied at baseline and during the last months to establish intra-observer reliability. ROC curves and a multinomial regression model were constructed to evaluate the effect of age and education on MoCA-S performance.

RESULTS

The mean age of the participants was 76±8.1 years and the education rate was 10.7±5.2. The MoCA-S scores by group were: CHG, 27.3±1.9; MCI, 22.9±2.9; and dementia, 13.7±4.9 (p<0.001). The reliability of the MoCA-S was 0.89 and the intraclass correlation coefficient was 0.955. Sensitivity was 80% and specificity was 75%, with a cut-off point of 26 points for MCI (area under the curve, 0.886; p<0.001). For the dementia group, the sensitivity was 98% and specificity was 93%, with a cut-off point of 24points (area under the curve, 0.998; p<0.001). The multinomial regression showed no association with education and age for both the MCI and dementia groups.

CONCLUSIONS

The MoCA-S is a valid and reliable instrument for MCI and dementia screening in the Mexican population, even after adjusting for age and education.

Unspeakable motion: Selective action-verb impairments in Parkinson's disease patients without mild cognitive impairment

Parkinson's disease (PD) patients show marked impairments in processing action verbs, and to a lesser extent, concrete (specially, manipulable) nouns. However, it is still unclear to what extent deficits in each of these categories are influenced by more general cognitive dysfunctions, and whether they are modulated by the words' implied motility. To examine these issues, we evaluated 49 non-demented PD patients and 49 healthy volunteers in an oral production task. The patients were divided into two groups depending on the presence or absence of mild cognitive impairment (PD-MCI and PD-nMCI, respectively). Participants named pictures of actions varying in motion content (low and high) and of objects varying in manipulability (low and high). The PD-MCI group showed deficits across all four categories. However, PD-nMCI patients exhibited a selective difficulty for high-motion action verbs. This finding corroborates and refines previous results suggesting that disturbances of action-related lexico-semantic information in PD constitute a sui generis alteration manifested early in the course of the disease's physiopathology. Moreover, it suggests that the grounding of action verbs on motor circuits could depend on fine-grained intracategorical semantic distinctions.

Association of Increased Serum ACE Activity with Logical Memory Ability in Type 2 Diabetic Patients with Mild Cognitive Impairment

Background: Angiotensin-converting enzyme (ACE) is involved in the chronic complications of type 2 diabetes mellitus (T2DM) and Alzheimer's disease. This study aimed to assess the pathogenetic roles of ACE and the genetic predisposition of its insertion/deletion (I/D) polymorphism in mild cognitive impairment (MCI) among T2DM patients.

Methods: A total of 210 T2DM patients were enrolled. Among these patients, 116 satisfied the MCI diagnostic criteria and 94 exhibited healthy cognition. The cognitive functions of the patients were extensively assessed. The serum level and activity of ACE were measured via enzyme-linked immunosorbent assay and ultraviolet spectrophotography. The single-nucleotide polymorphisms of I/D gene of ACE were analyzed.

Results: The serum level and activity of ACE in diabetic MCI patients (p = 0.022 and p = 0.008, respectively) were both significantly higher than those in the healthy controls. A significant negative correlation was found between their ACE activity and logical memory test score (LMT) (p = 0.002). Multiple stepwise regression iterated the negative correlation between ACE activity and LMT score (p = 0.035). Although no significant difference was found in the genotype or allele distribution of ACE I/D polymorphism between the groups, the serum levels and activity of ACE were higher in the DD group than in the ID and II groups (p < 0.05).

Conclusions: Serum ACE activity could better predict logical memory in T2DM patients than ACE level. Further investigations on a large population size are necessary to test whether the D-allele of the ACE gene polymorphism is susceptible to memory deterioration.

Evaluation of cognitive impairment in elderly population with hypertension from a low-resource setting: Agreement and bias between screening tools

INTRODUCTION

The evaluation of cognitive impairment in adulthood merits attention in societies in transition and especially in people with chronic diseases. Screening tools available for clinical practice and epidemiological studies have been designed in high-income but not in resource-constrained settings. The aim of this study was to assess the agreement and bias of three common tools used for screening of cognitive impairment in people with hypertension: the modified Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Leganés Cognitive Test (LCT).

METHODS

A cross-sectional study enrolling participants with hypertension from a semi-urban area in Peru was performed. The three screening tools for cognitive impairment were applied on three consecutive days. The prevalence of cognitive impairment was calculated for each test. Pearson's correlation coefficients, Bland-Altman plots, and Kappa statistics were used to assess agreement and bias between screening tools.

RESULTS

We evaluated 139 participants, mean age 76.5 years (SD ± 6.9), 56.1% females. Cognitive impairment was found in 28.1% of individuals using LCT, 63.3% using MMSE, and 100% using MoCA. Correlation coefficients ranged from 0.501 between LCT and MoCA, to 0.698 between MMSE and MoCA. Bland-Altman plots confirmed bias between screening tests. The agreement between MMSE and LCT was 60.4%, between MMSE and MoCA was 63.3%, and between MoCA and LCT was 28.1%.

CONCLUSIONS

Three of the most commonly used screening tests to evaluate cognitive impairment showed major discrepancies in a resource-constrained setting, signaling towards a sorely need to develop and validate appropriate tools.

Improved predictive ability of the Montreal Cognitive Assessment for diagnosing dementia in a community-based study

Introduction

We compared the predictive ability of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to diagnose dementia in a community-based study.

Methods

A total of 276 people aged 60 years or older were enrolled. All of the participants were administered face-to-face interview questionnaires and MoCA and MMSE examinations. The receiver operating characteristic curve method and area under curve were performed to assess the predictive ability for diagnosing dementia.

Results

The 276 participants had a mean age of 67.9 ± 6.1 years and mean education duration of 11.4 ± 4.0 years. In general, the MoCA yielded higher AUCs (0.891) with favorable sensitivity (78 %) and excellent specificity (94 %) compared with the MMSE in differentiating the participants with and without dementia in either the total sample or all subgroups.

Conclusion

Our study determined a higher predictive ability in the MoCA than in the MMSE for diagnosing dementia according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria in a community-based sample with a broader range of education level.