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Abstract
Objective: To establish the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) when screening externally validated cognition in Parkinson disease (PD), by comparison with a PD-focused test (Scales for Outcomes in Parkinson disease–Cognition [SCOPA-COG]) and the standardized Mini-Mental State Examination (S-MMSE) as benchmarks.
Methods: A convenience sample of 114 patients with idiopathic PD and 47 healthy controls was examined in a movement disorders center. The 21 patients with dementia (PD-D) were diagnosed using Movement Disorders Society criteria, externally validated by detailed independent functional and neuropsychological tests. The 21 patients with mild cognitive impairment (PD-MCI) scored 1.5 SD or more below normative data in at least 2 measures in 1 of 4 cognitive domains. Other patients had normal cognition (PD-N).
Results: Primary outcomes using receiver operating characteristic (ROC) curve analyses showed that all 3 mental status tests produced excellent discrimination of PD-D from patients without dementia (area under the curve [AUC], 87%–91%) and PD-MCI from PD-N patients (AUC, 78%–90%), but the MoCA was generally better suited across both assessments. The optimal MoCA screening cutoffs were <21/30 for PD-D (sensitivity 81%; specificity 95%; negative predictive value [NPV] 92%) and <26/30 for PD-MCI (sensitivity 90%; specificity 75%; NPV 95%). Further support that the MoCA is at least equivalent to the SCOPA-COG, and superior to the S-MMSE, came from the simultaneous classification of the 3 PD patient groups (volumes under a 3-dimensional ROC surface, chance = 17%: MoCA 79%, confidence interval [CI] 70%–89%; SCOPA-COG 74%, CI 62%–86%; MMSE-Sevens item 56%, CI 44%–68%; MMSE-World item 62%, CI 50%–73%).
Conclusions: The MoCA is a suitably accurate, brief test when screening all levels of cognition in PD.
Footnotes
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Study funding: Supported by the Neurological Foundation of New Zealand (T.J.A., J.C.D.-A., R.W., R.P., M.R.M., J.K., S.W.), the Canterbury Medical Research Foundation (T.J.A., J.C.D.-A., M.R.M., R.W., R.K.), and the Neurology Trust (T.J.A., L.L.).
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- ADAS-Cog
- Alzheimer's Disease Assessment Scale–Cognition
- AUC
- area under the curve
- CDR
- Clinical Dementia Rating
- CI
- confidence interval
- DRS-2
- Dementia Rating Scale–2
- MDS
- Movement Disorders Society
- MMSE
- Mini-Mental State Examination
- MoCA
- Montreal Cognitive Assessment
- NPV
- negative predictive value
- PD
- Parkinson disease
- PD-D
- Parkinson disease with dementia
- PD-MCI
- Parkinson disease with mild cognitive impairment
- PD-N
- Parkinson disease with normal cognition
- R-IADL
- Reisberg instrumental activities of daily living
- ROC
- receiver operating characteristic
- S-MMSE
- standardized Mini-Mental State Examination
- SCOPA-COG
- Scales for Outcomes in Parkinson disease–Cognition
- VUS
- volume under a surface
- Received April 12, 2010.
- Accepted July 20, 2010.
- Copyright © 2010 by AAN Enterprises, Inc.
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