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Defining and validating a short form Montreal Cognitive Assessment (s-MoCA) for use in neurodegenerative disease.

ABSTRACT: INTRODUCTION:Screening for cognitive deficits is essential in neurodegenerative disease. Screening tests, such as the Montreal Cognitive Assessment (MoCA), are easily administered, correlate with neuropsychological performance and demonstrate diagnostic utility. Yet, administration time is too long for many clinical settings. METHODS:Item response theory and computerised adaptive testing simulation were employed to establish an abbreviated MoCA in 1850 well-characterised community-dwelling individuals with and without neurodegenerative disease. RESULTS:8 MoCA items with high item discrimination and appropriate difficulty were identified for use in a short form (s-MoCA). The s-MoCA was highly correlated with the original MoCA, showed robust diagnostic classification and cross-validation procedures substantiated these items. DISCUSSION:Early detection of cognitive impairment is an important clinical and public health concern, but administration of screening measures is limited by time constraints in demanding clinical settings. Here, we provide as-MoCA that is valid across neurological disorders and can be administered in approximately 5?min.

SUBMITTER: Roalf DR

PROVIDER: S-EPMC5061594 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Defining and validating a short form Montreal Cognitive Assessment (s-MoCA) for use in neurodegenerative disease.

Roalf David R DR Moore Tyler M TM Wolk David A DA Arnold Steven E SE Mechanic-Hamilton Dawn D Rick Jacqueline J Kabadi Sushila S Ruparel Kosha K Chen-Plotkin Alice S AS Chahine Lama M LM Dahodwala Nabila A NA Duda John E JE Weintraub Daniel A DA Moberg Paul J PJ

Journal of neurology, neurosurgery, and psychiatry 20160412 12

<h4>Introduction</h4>Screening for cognitive deficits is essential in neurodegenerative disease. Screening tests, such as the Montreal Cognitive Assessment (MoCA), are easily administered, correlate with neuropsychological performance and demonstrate diagnostic utility. Yet, administration time is too long for many clinical settings.<h4>Methods</h4>Item response theory and computerised adaptive testing simulation were employed to establish an abbreviated MoCA in 1850 well-characterised community ...[more]

PMID: 27071646

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Project description:IntroductionShort forms of the Montreal Cognitive Assessment (MoCA) have allowed quick cognitive screening. However, none of the available short forms has been created or validated in a Swedish sample of patients with stroke.The aim is to develop a short-form Swedish version of the MoCA (s-MoCA-SWE) in a sample of patients with acute and subacute stroke. The specific objectives are: (1) to identify a subgroup of MoCA items that have the potential to form the s-MoCA-SWE; (2) to determine the optimal cut-off value of s-MoCA-SWE for predicting cognitive impairment and (3) and to compare the psychometric properties of s-MoCA-SWE with those of previously developed MoCA short forms.Methods and analysisThis is a statistical analysis protocol for a cross-sectional study. The study sample will comprise patients from Väststroke, a local stroke registry from Gothenburg, Sweden and Efficacy oF Fluoxetine-a randomisEd Controlled Trial in Stroke (EFFECTS), a randomised controlled trial in Sweden. The s-MoCA-SWE will be developed by using exploratory factor analysis and the boosted regression tree algorithm. The cut-off value of s-MoCA-SWE for impaired cognition will be determined based on binary logistic regression analysis. The psychometric properties of s-MoCA-SWE will be compared with those of other MoCA short forms by using cross-tabulation and area under the receiving operating characteristic curve analyses.Ethics and disseminationThe Väststroke study has received ethical approval from the Regional Ethical Review Board in Gothenburg (346-16) and the Swedish Ethical Review Authority (amendment 2019-04299). The handling of data generated within the framework of quality registers does not require written informed consent from patients. The EFFECTS study has received ethical approval from the Stockholm Ethics Committee (2013/1265-31/2 on 30 September 2013). All participants provided written consent. Results will be published in an international, peer-reviewed journal, presented at conferences and communicated to clinical practitioners in local meetings and seminars.

Project description:PurposeMany age-related structural and functional changes in the brain have important consequences. Long-term exposure to mercury and the impact of functional polymorphisms of metal-regulating proteins such as metallothioneins (MTs) can result in neurological-neurobehavioral effects in elderly individuals. Therefore, the aims of this study are to examine the associations between biomarkers of mercury exposure and cognitive impairment and to investigate the effect of the rs8052394 single nucleotide polymorphism (SNP) of the potential modifier gene MT1A on different domains of the Montreal Cognitive Assessment (MoCA).Materials and methodsWe studied 436 participants aged ≥55 years from the Electricity Generating Authority of Thailand study. They underwent a physical examination, an extensive cognitive assessment with the MoCA (cutoff <26 points), and a biochemical analysis related to diabetes and dyslipidemia. The blood mercury level was determined by inductively coupled plasma mass spectrometry. Genotyping of the MT1A rs8052394 SNP was performed by the restriction fragmentation length polymorphism method.ResultsThe mean age of the study population was 58.8±3.01 years, and most had ≥12 years of education (75.7%). The primary study finding was that the prevalence of mild cognitive impairment (MCI) in older Thai adults was 39.7%. The frequency distributions of the G allele of the rs8052394 SNP of the MT1A gene were significantly associated with the total and sub-domain MoCA scores. The prevalence of MCI was significantly associated with increased age, hypertriglyceridemia, hyperhomocysteinemia, the third tertile of blood mercury concentration, and the rs8052394 variant genotype of MT1A (P values for all odds ratios <0.05).ConclusionThese findings suggested that neurocognitive effects associate with mercury exposure and genetic susceptibility in toxicokinetics. Public health strategies can be used to implement as a comprehensive action plan to educate vulnerable populations on how to reduce mercury exposure. Concurrently, impact of such genetic predisposition requires replication for identifying and protecting susceptible individuals from mercury toxicity.

Project description:OBJECTIVES:While various short variants of the Montreal Cognitive Assessment (MoCA) have been developed, they have not been compared among each other to determine the most optimal variant for routine use. This study evaluated the comparative performance of the short variants in identifying mild cognitive impairment or dementia (MCI/dementia). DESIGN:Baseline data of a cohort study. SETTING:Alzheimer's Disease Centers across the United States. PARTICIPANTS:Participants aged ?50 years (n = 4606), with median age 70 (interquartile range 65-76). MEASURES:Participants completed MoCA and were evaluated for MCI/dementia. The various short variants of MoCA were compared in their performance in discriminating MCI/dementia, using areas under the receiver operating characteristic curve (AUCs). RESULTS:All 7 short variants of MoCA had acceptable performance in discriminating MCI/dementia from normal cognition (AUC 87.7%-91.0%). However, only 2 variants by Roalf et al (2016) and Wong et al (2015) demonstrated comparable performance (AUC 88.4-88.9%) to the original MoCA (AUC 89.3%). Among the participants with higher education, only the variant by Roalf et al had similar AUC to the original MoCA. At the optimal cut-off score of <25, the original MoCA demonstrated 84.4% sensitivity and 76.4% specificity. In contrast, the short variant by Roalf et al had 87.2% sensitivity and 72.1% specificity at its optimal cut-off score of <13. CONCLUSIONS/IMPLICATIONS:The various short variants may not share similar diagnostic performance, with many limited by ceiling effects among participants with higher education. Only the short variant by Roalf et al was comparable to the original MoCA in identifying MCI or dementia even across education subgroups. This variant is one-third the length of the original MoCA and can be completed in <5 minutes. It provides a viable alternative when it is not feasible to administer the original MoCA in clinical practice and can be especially useful in nonspecialty clinics with large volumes of patients at high risk of cognitive impairment (such as those in primary care, geriatric, and stroke prevention clinics).

Dataset Information

Defining and validating a short form Montreal Cognitive Assessment (s-MoCA) for use in neurodegenerative disease.

Publications

Defining and validating a short form Montreal Cognitive Assessment (s-MoCA) for use in neurodegenerative disease.

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