Comparative sensitivity of the MoCA and Mattis Dementia Rating Scale‐2 in Parkinson's disease

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Abstract

Clinicians and researchers commonly use global cognitive assessments to screen for impairment. Currently there are no published studies directly comparing the sensitivity and specificity of the MoCA and Mattis Dementia Rating Scale-2(DRS-2) in PD. To identify the relative sensitivity and specificity of the MoCA and DRS-2 in PD. The MoCA and DRS-2 were administered to training and validation cohorts. Cutoff scores were determined within the training cohort (n=85) to optimize sensitivity and specificity for cognitive impairment and were applied to an independent validation cohort(n=521). The MoCA was consistently sensitive across training and validation cohorts(90.0%, 80.3%, respectively), whereas the DRS-2 was not(87.5%, 60.3%, respectively). In individual domains, the MoCA remained sensitive to memory and visuospatial impairments(91.9% and 87.8%, respectively), whereas the DRS-2 was sensitive to executive impairments(86.2%). The MoCA and DRS-2 demonstrated individual strengths. Future work should focus on developing domain-specific cognitive screening tools for PD.

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Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease.

S Hoops, S Nazem, A Siderowf … (2009)

Due to the high prevalence of mild cognitive impairment (MCI) and dementia in Parkinson disease (PD), routine cognitive screening is important for the optimal management of patients with PD. The Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting MCI and dementia in patients without PD, but its validity in PD has not been established. A representative sample of 132 patients with PD at 2 movement disorders centers was administered the MoCA, MMSE, and a neuropsychological battery with operationalized criteria for deficits. MCI and PD dementia (PDD) criteria were applied by an investigator blinded to the MoCA and MMSE results. The discriminant validity of the MoCA and MMSE as screening and diagnostic instruments was ascertained. Approximately one third of the sample met diagnostic criteria for a cognitive disorder (12.9% PDD and 17.4% MCI). Mean (SD) MoCA and MMSE scores were 25.0 (3.8) and 28.1 (2.0). The overall discriminant validity for detection of any cognitive disorder was similar for the MoCA and the MMSE (receiver operating characteristic area under the curve [95% confidence interval]): MoCA (0.79 [0.72, 0.87]) and MMSE (0.76 [0.67, 0.85]), but as a screening instrument the MoCA (optimal cutoff point = 26/27, 64% correctly diagnosed, lack of ceiling effect) was superior to the MMSE (optimal cutoff point = 29/30, 54% correctly diagnosed, presence of ceiling effect). The Montreal Cognitive Assessment, but not the Mini-Mental State Examination, has adequate psychometric properties as a screening instrument for the detection of mild cognitive impairment or dementia in Parkinson disease. However, a positive screen using either instrument requires additional assessment due to suboptimal specificity at the recommended screening cutoff point.

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The MoCA: well-suited screen for cognitive impairment in Parkinson disease.

J C Dalrymple-Alford, M R MacAskill, C T Nakas … (2010)

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. 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). 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%). The MoCA is a suitably accurate, brief test when screening all levels of cognition in PD.

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Movement Disorders Society Scientific Issues Committee report: SIC Task Force appraisal of clinical diagnostic criteria for Parkinsonian disorders.

Irene Litvan, Kailash P. Bhatia, David Burn … (2003)

As there are no biological markers for the antemortem diagnosis of degenerative parkinsonian disorders, diagnosis currently relies upon the presence and progression of clinical features and confirmation depends on neuropathology. Clinicopathologic studies have shown significant false-positive and false-negative rates for diagnosing these disorders, and misdiagnosis is especially common during the early stages of these diseases. It is important to establish a set of widely accepted diagnostic criteria for these disorders that may be applied and reproduced in a blinded fashion. This review summarizes the findings of the SIC Task Force for the study of diagnostic criteria for parkinsonian disorders in the areas of Parkinson's disease, dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration. In each of these areas, diagnosis continues to rest on clinical findings and the judicious use of ancillary studies. Copyright 2003 Movement Disorder Society

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Author and article information

Journal

Title: Movement Disorders

Abbreviated Title: Mov Disord.

Publisher: Wiley

ISSN (Print): 0885-3185

ISSN (Electronic): 1531-8257

Publication date Created: January 17 2019

Publication date Created: February 2019

Publication date (Electronic): December 10 2018

Publication date (Print): February 2019

Volume: 34

Issue: 2

Pages: 285-291

Affiliations

[1 ]Department of Psychological and Brain SciencesWashington University St. Louis Missouri USA

[2 ]Department of Neurology and Neurological SciencesStanford University School of Medicine Stanford California USA

[3 ]Veterans Affairs Puget Sound Health Care System Seattle Washington USA

[4 ]Department of NeurologyUniversity of Washington School of Medicine Seattle Washington USA

[5 ]Department of NeurologyOregon Health Sciences University Portland Oregon USA

[6 ]Department of EpidemiologyUniversity of California, Irvine School of Medicine Irvine California USA

[7 ]Lou Ruvo Center for Brain HealthNeurological Institute, Cleveland Clinic Cleveland Ohio USA

[8 ]Department of PathologyStanford University School of Medicine Stanford California USA

[9 ]Department of NeurosurgeryStanford University School of Medicine Stanford California USA

Article

DOI: 10.1002/mds.27575

PMC ID: 6532623

PubMed ID: 30776152

SO-VID: 6c545444-5cf1-4e52-bbe3-a13a342d056a

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Comparative sensitivity of the MoCA and Mattis Dementia Rating Scale‐2 in Parkinson's disease

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Most cited references 16

Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease.

The MoCA: well-suited screen for cognitive impairment in Parkinson disease.

Movement Disorders Society Scientific Issues Committee report: SIC Task Force appraisal of clinical diagnostic criteria for Parkinsonian disorders.

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