Comparison of the Folstein Mini Mental State Examination (MMSE) to the Montreal Cognitive Assessment (MoCA) as a Cognitive Screening Tool in an Inpatient Rehabilitation Setting

Arun Aggarwal,Emma Kean

doi:10.4236/nm.2010.12006

Abstract

Identifying the presence of cognitive impairment in patients admitted for inpatient rehabilitation is important as it may impact on their ability to participate in a rehabilitation program. The Folstein Mini Mental State Examination (MMSE) has been used by clinicians as a cognitive screening tool for its convenience, even though it is not sensitive, and often fails to detect cognitive impairment. Recently, the Montreal Cognitive Assessment (MoCA) has been developed as a brief cognitive screening tool to detect mild-moderate cognitive impairment. We performed a longitudinal study to compare the utility of the MMSE and MoCA in an inpatient rehabilitation setting. A total of 50 consecutive patients were studied with an average age of 71.7 years of age. The mean test score for MMSE was 26.5 and 22.2 for the MoCA. The Pearson’s correlation coefficient between the scores was 0.695 (p < 0.003). The mean performance time for the MMSE was 7.4 minutes and 14.8 minutes for the MoCA. MMSE did not perform well as a screening instrument for mild cognitive impairment as there were 43 patients who scored 24 or more on MMSE, and 25 patients (58%) scored 25 or less on MoCA, indicating the presence of cognitive impairment. Even though the MoCA takes longer to administer, the additional important information provided indicates that the MoCA should be used rather than the MMSE as a cogni-tive screening tool.

Highlights

Mild cognitive impairment is common in elderly patients and can impact on prognosis and quality of life [1]
This study compares the utility of the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in an inpatient rehabilitation setting for everyday clinical use
This is a study using MoCA in an inpatient rehabilitation setting and comparing the utility of the MMSE and MoCA in an inpatient rehabilitation setting for everyday clinical use

Summary

Introduction

Mild cognitive impairment is common in elderly patients and can impact on prognosis and quality of life [1]. Identification of mild cognitive impairment in patients admitted for inpatient rehabilitation is important as this may an impact on their ability to participate actively in a multi-disciplinary rehabilitation program and achieve their rehabilitation goals. The most commonly used cognitive screening tool, the Folstein Mini Mental State Examination (MMSE) [4], is convenient, but not sensitive, as it is influenced by age, socio-economic status and level of education. It assesses primarily language and memory skills and has been found to be insensitive to detecting mild cognitive impairment [5]. There is a need for a brief, accurate and performed screening test

Methods

Results

Conclusion