Abstract
Background: The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are the most commonly used tools for cognitive impairment screening. The present study aimed to investigate the ability of the MOCA and MMSE to differentiate between cognitively normal elderly individuals, MCI patients and dementia patients at different ages and education levels and to establish the optimal cutoff scores of the MoCA and MMSE for MCI and dementia in the Chinese elderly.Methods: A total of 2,954 Chinese elderly individuals, including 1,746 normal controls, 599 MCI patients and 249 dementia patients, were consecutively recruited in the study. The optimal cutoffs for MoCA and MMSE were determined using receiver operating characteristic (ROC) analysis among the different age and education levels in the three groups. Furthermore, comparison of ROC curves were made to evaluate the performances of the two tests.Results: The area under the curve(AUC) of the MoCA (0.82) for detecting MCI was significantly higher than that of the MMSE (0.75) (P < 0.001). When the sample was divided according to age and education level, the AUC of the MoCA (0.84) was higher than those of the MMSE (0.71) for MCI (P < 0.001) in the younger and more highly-educated groups. The optimal cutoff scores of the MoCA for the groups aged ≤ 75 years old and education ≤ 6 years, aged > 75 years old and education ≤ 6 years, aged ≤ 75 years old and education > 6 years, aged > 75 years old and education > 6 years in screening for MCI were identified as 19.5, 15.5, 24.5 and 24.5, respectively, and the optimal cutoff scores for dementia were 18.5, 10.5, 18.5 and 20.5, respectively. For MMSE in the above four groups, the cutoff scores to detect MCI were 26.5, 22.5, 28.5 and 26.5, respectively, and the optimal cutoff scores for dementia were 23.5, 19.5, 23.5 and 23.5, respectively.Conclusion: Compared to MMSE, the MoCA is more suitable for discriminating MCI in younger and more highly educated elderly Chinese individuals. However, the MMSE has advantage over MoCA in screening MCI in individuals with lower education levels and the older groups of Chinese elderly.
Highlights
With an aging population, the number of patients with dementia has increased worldwide
Among the 2,954 participants in this study, 974 (37.5%) were aged ≥ 75 years old, 860 (33.2%) had 6 years of education or fewer, and 1,121 (43.2%) were male. Based on their clinical diagnoses, the participants were divided into three groups: 599 (23.1%) participants with Mild cognitive impairment (MCI), aMCI accounted for 82.97% and vMCI accounted for 17.03%. 249 (9.6%) participants with dementia, including Alzheimer’s disease (65.86%), Vascular dementia (29.32%) and other dementias (4.82%). 1746 (67.3%) participants who were cognitively normal (Table 1)
The results indicated that the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) both distinguished between normal cognition and dementia significantly with Area Under the Curve (AUC) > 0.9
Summary
The number of patients with dementia has increased worldwide. Mild cognitive impairment (MCI) is a transitional level between the normal state of the brain and dementia [2], and the prevalence of MCI in adults aged ≥ 65 years is 10– 20%. MCI is associated with a high risk of dementia, it sometimes remains normal or slightly decreases cognitive function without any notable interference in daily life activities [3]. If the progression of MCI to dementia could be delayed by 5 years, the prevalence of dementia would drop by 43% by 2050 [1]. The present study aimed to investigate the ability of the MOCA and MMSE to differentiate between cognitively normal elderly individuals, MCI patients and dementia patients at different ages and education levels and to establish the optimal cutoff scores of the MoCA and MMSE for MCI and dementia in the Chinese elderly
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