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November 09, 2010; 75 (19) Articles

The MoCA

Well-suited screen for cognitive impairment in Parkinson disease

J.C. Dalrymple-Alford, M.R. MacAskill, C.T. Nakas, L. Livingston, C. Graham, G.P. Crucian, T.R. Melzer, J. Kirwan, R. Keenan, S. Wells, R.J. Porter, R. Watts, T.J. Anderson
First published November 8, 2010, DOI: https://doi.org/10.1212/WNL.0b013e3181fc29c9
J.C. Dalrymple-Alford
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M.R. MacAskill
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C.T. Nakas
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L. Livingston
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C. Graham
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G.P. Crucian
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T.R. Melzer
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J. Kirwan
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R. Keenan
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S. Wells
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R. Watts
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T.J. Anderson
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Citation
The MoCA
Well-suited screen for cognitive impairment in Parkinson disease
J.C. Dalrymple-Alford, M.R. MacAskill, C.T. Nakas, L. Livingston, C. Graham, G.P. Crucian, T.R. Melzer, J. Kirwan, R. Keenan, S. Wells, R.J. Porter, R. Watts, T.J. Anderson
Neurology Nov 2010, 75 (19) 1717-1725; DOI: 10.1212/WNL.0b013e3181fc29c9

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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

  • 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.).

  • 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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Letters: Rapid online correspondence

  • The MoCA: Well-suited screen for cognitive impairment in Parkinson disease
    • Johan Marinus, Senior Researcher, Leiden University Medical Centerj.marinus@lumc.nl
    • Dagmar Verbaan, Jacobus J. van Hilten
    Submitted February 02, 2011
  • Reply from the authors
    • John C. Dalrymple-Alford, Associate Professor, Van der Veer Institute for Parkinson's and Brain Researchjohn.dalrymple-alford@canterbury.ac.nz
    • C.T. Nakas, PhD, M.R. MacAskill, PhD, L. Livingston, BA, and T.J. Anderson, MD
    Submitted February 02, 2011
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Topics Discussed

  • All Cognitive Disorders/Dementia
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  • Parkinson's disease with dementia
  • Assessment of cognitive disorders/dementia
  • MCI (mild cognitive impairment)

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