Comparing and linking the Mini-Mental State Examination and Montreal Cognitive Assessment in the Amsterdam Dementia Cohort.

Abstract

We aimed to compare and link the total scores of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), two common global cognitive screeners. 2,325 memory clinic patients (63.2 ± 8.6 years; 43% female) with a variety of diagnoses, including subjective cognitive decline, mild cognitive impairment, and dementia due to various etiologies completed the MMSE and MoCA concurrently. We described both screeners, including at the item level. Then, using linear regressions, we investigated how age, sex, education, and diagnosis affected total scores on both instruments. Next, in linear mixed models, we treated the two screeners as repeated measures and analyzed the influence of these characteristics on the relationship between the instruments' total scores. Finally, we linked total scores using equipercentile equating, accounting for relevant patient characteristics. MMSE scores (mean ± standard deviation: 25.0 ± 4.6) were higher than MoCA scores (21.2 ± 5.4), and MMSE items generally showed less variation than MoCA items. Both instruments' scores were individually influenced by age, sex, education, and diagnosis. The relationship between the screeners was moderated by age (estimate = -0.01, 95% confidence interval = [-0.03, -0.00]), education (0.14 [0.10, 0.18]), and diagnosis. These were accounted for when producing crosswalk tables based on equipercentile equating. Accounting for the influence of patient characteristics, we created crosswalk tables to convert MMSE scores to MoCA scores, and vice versa. These tables may facilitate collaboration between clinicians and researchers and could allow larger, pooled analyses of global cognitive functioning in older adults.