Dataset Information

Enhanced diagnostic accuracy for neurocognitive disorders: a revised cut-off approach for the Montreal Cognitive Assessment.

ABSTRACT:

Background

The Montreal Cognitive Assessment (MoCA) has good sensitivity for mild cognitive impairment, but specificity is low when the original cut-off (25/26) is used. We aim to revise the cut-off on the German MoCA for its use in clinical routine.

Methods

Data were analyzed from 496 Memory Clinic outpatients (447 individuals with a neurocognitive disorder; 49 with cognitive normal findings) and from 283 normal controls. Cut-offs were identified based on (a) Youden's index and (b) the 10th percentile of the control group.

Results

A cut-off of 23/24 on the MoCA had better correct classification rates than the MMSE and the original MoCA cut-off. Compared to the original MoCA cut-off, the cut-off of 23/24 points had higher specificity (92% vs 63%), but lower sensitivity (65% vs 86%). Introducing two separate cut-offs increased diagnostic accuracies with 92% specificity (23/24 points) and 91% sensitivity (26/27 points). Scores between these two cut-offs require further examinations.

Conclusions

Using two separate cut-offs for the MoCA combined with scores in an indecisive area enhances the accuracy of cognitive screening.

SUBMITTER: Thomann AE

PROVIDER: S-EPMC7140337 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Publications

Enhanced diagnostic accuracy for neurocognitive disorders: a revised cut-off approach for the Montreal Cognitive Assessment.

Thomann Alessandra E AE Berres Manfred M Goettel Nicolai N Steiner Luzius A LA Monsch Andreas U AU

Alzheimer's research & therapy 20200407 1

<h4>Background</h4>The Montreal Cognitive Assessment (MoCA) has good sensitivity for mild cognitive impairment, but specificity is low when the original cut-off (25/26) is used. We aim to revise the cut-off on the German MoCA for its use in clinical routine.<h4>Methods</h4>Data were analyzed from 496 Memory Clinic outpatients (447 individuals with a neurocognitive disorder; 49 with cognitive normal findings) and from 283 normal controls. Cut-offs were identified based on (a) Youden's index and ( ...[more]

PMID: 32264975

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Project description:Given advantages in reperfusion therapy leading to mild stroke, less apparent cognitive deficits can be overseen in a routine neurological examination. Despite the widespread use of the Montreal Cognitive Assessment (MoCA), age- and education-specific cutoffs for the detection of post-stroke cognitive impairment (PSCI) are not established, hampering its valid application in stroke. We aimed to establish age- and education-specific MoCA cutoffs to better discriminate patients with and without acute PSCI. Patients with acute ischemic stroke underwent the MoCA and a detailed neuropsychological assessment. PSCI was defined as a performance < - 1.5 SD in ≥ 2 cognitive domains. As secondary data analysis, the discriminant abilities of the MoCAraw-score (not adding + 1 as correction for ≤ 12 years of education, YoE) cutoffs were automatically derived based on Youden Index and evaluated by receiver operating characteristic analyses across age- (< 55, 55-70, > 70 years old) and education-specific (≤ 12 and > 12 YoE) groups. 351 stroke patients (67.4 ± 14.1 years old; 13.1 ± 2.8 YoE) underwent the neuropsychological assessment 2.7 ± 2.0 days post-stroke. The original MoCA cutoff < 26 falsely classified 26.2% of examined patients, with poor sensitivity in younger adults (34.8% in patients < 55 years > 12 YoE) and poor specificity in older adults (55.0%, in > 70 years ≤ 12 YoE). By maximizing both sensitivity and specificity, the optimal MoCAraw cutoffs were: (i) < 28 in patients aged < 55 with > 12 YoE (sensitivity = 69.6%, specificity = 77.8%); (ii) < 22 and < 25 in patients > 70 years with ≤ 12 and > 12 YoE (sensitivity = 61.6%, specificity = 90.0%; sensitivity = 63.3%, specificity = 84.0%, respectively). In other groups the optimal MoCAraw cutoff was < 26. Age and education level should be considered when interpreting MoCA-scores. Though new age- and education-specific cutoffs demonstrated higher discriminant ability for PSCI, their performance in young stroke and adults with higher education level was low due to ceiling effects and MoCA subtests structure, and cautious interpretation in these patients is warranted.Trial registration: ClinicalTrials.gov Identifier: NCT05653141.

Project description:ObjectivesMontreal Cognitive Assessment (MoCA) total scores have been widely used to identify individuals with neurocognitive disorders (NCDs), but the utility of its domain-specific scores have yet to be thoroughly interrogated. This study aimed to validate MoCA's 6 domain-specific scores (ie, Memory, Language, Attention, Executive, Visuospatial, and Orientation) with conventional neuropsychological tests and explore whether MoCA domain scores could discriminate between different etiologies in early NCDs.DesignBaseline data of a cohort study.Setting and participantsStudy included 14,571 participants recruited from Alzheimer's Disease Centers across United States, aged ≥50 years, with global Clinical Dementia Rating of ≤1, and mean age of 71.8 ± 8.9 years.MethodsParticipants completed MoCA, conventional neuropsychological tests, and underwent standardized assessments to diagnose various etiologies of NCDs. Partial correlation coefficient was used to examine construct validity between Z scores of neuropsychological tests and MoCA domain scores, whereas multinomial logistic regression examined utility of domain scores to differentiate between etiologies of early NCDs.ResultsMoCA domain scores correlated stronger with equivalent constructs (r = 0.15-0.43, P < .001), and showed divergence from dissimilar constructs on neuropsychological tests. Participants with Alzheimer's disease were associated with greater impairment in Memory, Attention, Visuospatial, and Orientation domains (RRR = 1.13-1.55, P < .001). Participants with Lewy body disease were impaired in Attention and Visuospatial domains (RRR = 1.21-1.47, P < .001); participants with frontotemporal lobar degeneration were impaired in Language, Executive, and Orientation domains (RRR = 1.25-1.75, P < .01); and participants with Vascular disease were impaired in Attention domain (RRR = 1.14, P < .001).Conclusions and implicationsMoCA domain scores approximate well-established neuropsychological tests and can be valuable in discriminating different etiologies of early NCDs. Although MoCA domain scores may not fully substitute neuropsychological tests, especially in the context of diagnostic uncertainties, they can complement MoCA total scores as part of systematic evaluation of early NCDs and conserve the use of neuropsychological tests to patients who are more likely to require further assessments.

Dataset Information

Enhanced diagnostic accuracy for neurocognitive disorders: a revised cut-off approach for the Montreal Cognitive Assessment.

Background

Methods

Results

Conclusions

Publications

Enhanced diagnostic accuracy for neurocognitive disorders: a revised cut-off approach for the Montreal Cognitive Assessment.

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