![]() ![]() Galvin and Sadowski recently wrote clinical recommendations for primary care physician evaluation of older patients for cognitive impairment, emphasizing the need to look for early warning signs where formal cognitive testing can aid detection. Office-based, multi-domain cognitive tests are commonly administered in clinical situations to evaluate patients with cognitive impairment. MoCA scores are translatable to the MMSE to facilitate comparison. Functional assessment can help exclude dementia cases. A cutoff of ≥17 on the MoCA may help capture early and late MCI cases depending on the level of sensitivity desired, ≥18 or 19 could be used. MoCA and MMSE were more similar for dementia cases, but MoCA distributes MCI cases across a broader score range with less ceiling effect. Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC. The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful. ROC analysis found MoCA ≥ 17 as the cutoff between MCI and dementia that emphasized high sensitivity (92.3 %) to capture MCI cases. Equi-percentile equating showed a MoCA score of 18 was equivalent to MMSE of 24. ![]() MoCA and MMSE scores correlated most for dementia ( r = 0.86 versus MCI r = 0.60 HC r = 0.43). The ceiling effect (28–30 points) for MCI and HC was less using MoCA (18.1 %) versus MMSE (71.4 %). Most dementia cases scored abnormally, while MCI and HC score distributions overlapped on each test. Receiver Operating Characteristic (ROC) analyses evaluated lower cutoff scores for capturing the most MCI cases. Equi-percentile equating produced a translation grid for MoCA against MMSE scores. Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI. Stepwise variable selection in logistic regression evaluated relative value of four test domains for separating MCI from HC. ![]() Methodsįor this cross-sectional study, we analyzed 219 healthy control (HC), 299 MCI, and 100 Alzheimer’s disease (AD) dementia cases from the Alzheimer’s Disease Neuroimaging Initiative (ADNI)-GO/2 database to evaluate MMSE and MoCA score distributions and select MoCA values to capture early and late MCI cases. Clinicians need to better understand the relationship between MoCA and MMSE scores. “There's no broad consensus that we should be giving MoCA's to people as part of their wellness examination or general annual physical,” he said.The Montreal Cognitive Assessment (MoCA) was developed to enable earlier detection of mild cognitive impairment (MCI) relative to familiar multi-domain tests like the Mini-Mental State Exam (MMSE). The Montreal test is not a routine screening test in the same way a colonoscopy or a mammogram are, Honig said. “If you're looking for Alzheimer's, then you'd be reassured to say that there's no signs of that disease,” Nasreddine said, referring to a perfect score on the test. A person with a a high school education in the United States should be able to get 26 to 30, Honig said. This is because there are often confounding factors such as the level of education and whether the test is being given in the person’s native language. He has seen patients with dementia score greater than 26 and he has seen patients without dementia score below 26. Lawrence Honig, a neurologist and one of the directors of the Alzheimer's Disease Research Center at Columbia University, said while the test is a pretty good indicator, it’s not perfect. ![]()
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