Multi-modal approaches to Alzheimer's disease diagnosis: Combining cognitive assessments with biomarkers and imaging.

BackgroundAlzheimer's disease (AD) is a progressive neurodegenerative disorder and the leading cause of dementia, posing significant global health and societal challenges. Lecanemab is a disease‐modifying therapy approved for mild AD. In this report, we present real‐world data on the efficacy and safety of lecanemab, and explore the role of AD‐related serum biomarkers in monitoring treatment efficacy in a real‐world setting.MethodCognitive function was assessed using AD assessment scale‐cognition (ADAS‐Cog), clinical dementia rating scale—sum of boxes (CDR‐SB), montreal cognitive assessment (MoCA), mini‐mental state examination (MMSE), and frontal assessment battery (FAB) at baseline and every follow‐up. Serum biomarkers, including neurofilament light chain (NFL), glial fibrillary acidic protein (GFAP), Aβ 1‐40, Aβ 1‐42, p‐tau 181, and p‐tau 217, were monitored with chemiluminescence assay at all time points.ResultFifty‐one AD patients meeting ATN criteria were enrolled (CDR 0.5: n = 25; CDR 1: n = 14; CDR 2: n = 12). Significant improvements were observed in ADAS‐Cog (+4.36 points, p <0.001), CDR‐SB (+0.31 points, p = 0.010), and MoCA (+1.40 points, p = 0.002) at 7 months, with no significant change in MMSE. Only serum p‐tau 181 decreased significantly (p = 0.031), while p‐tau 217 showed a non‐significant trend. Spearman correlation analysis revealed associations between serum p‐tau181, p‐tau217, and cognitive scores. The adjusted linear mixed‐effects model indicated a significant association between serum p‐tau 181 and ADAS‐Cog scores (β=0.3546, p <0.001). No serious adverse events occurred. Infusion reactions were reported in 7.69% of patients, and 9.62% discontinued due to asymptomatic amyloid‐related imaging abnormalities (ARIA).ConclusionIn the real world, lecanemab may be safe and effective in the treatment of mild‐to‐moderate AD, and dynamic monitoring of serum p‐tau 181 may be helpful to observe the efficacy during treatment. AD patients with severe cognitive impairment and significant white matter lesions should be closely monitored for adverse reactions, such as ARIA.

A-02 Comparing Rate of Change in MoCA and MMSE Scores Over Time in an MCI and AD sample

BackgroundTraumatic Brain Injury (TBI) is the most common cause of injury-related death and disability globally, and a common sequelae is cognitive impairment. Addressing post-TBI cognitive deficits is crucial because they affect rehabilitation outcomes, but doing this requires valid and reliable cognitive assessment measures. However, no such instrument has been validated in Tanzania’s TBI population. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are two commonly used instruments to measure cognitive impairment, and there have been a few studies reporting their use in post-TBI cognitive assessment. Our aim was to report the psychometric properties of the Swahili version of both scales amongst the TBI population in Tanzania.MethodsA cross-cultural adaptation committee participated in the translation and content validation process for both questionnaires. Our patient sample consisted of 192 adults with TBI who were admitted to Kilimanjaro Christian Medical Center (KCMC) in Tanzania. Confirmatory factor analysis, reliability and external validity were evaluated.ResultsMoCA showed adequate factor loadings (values > 0.50 for all items except items 7 & 10) and adequate reliability (values > 0.70). Factor loadings for most of the MMSE items were below 0.5 and internal consistency was medium (< 0.7). Polychoric correlation between MMSE and MoCA was strong, positive and statistically significant (r = 0.68, p = 0.001); correlation with the cognitive subscale of FIM indicated moderately positive relationships - MMSE (r = 0.35, p = 0.001) and MoCA (r = 0.43, p = 0.001).ConclusionsWith the exception of the language and memory items, MoCA is a valid and reliable instrument for cognitive impairment screening in Tanzania’s adult TBI population. On the other hand, MMSE does not appear to be an appropriate tool in this patient group, but its positive correlations with MoCA and cFIM indicate similar theoretical concepts. Both instruments require further validation studies to prove their predictive ability for screening cognitive impairment before they are considered suitable for clinical use.

Objective To explore the predictive value of short term cognitive assessment in the acute phase of ischemic stroke for 3-6 months after stroke. Methods The demographic data, vascular risk factors, clinical and imaging data of 254 patients with acute ischemic stroke from August 2016 to December 2017 were prospectively registered.The cognitive function was assessed by Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) 3 weeks after stroke onset.Comprehensive cognitive function assessment was performed after 3-6 months of stroke.Multiple factor Logistic regression was used to screen the independent risk factors of cognitive domain and overall cognitive function in 3-6 months. Results Totally 254 consecutive patients with acute ischemic stroke were enrolled.Combined with the inclusion and exclusion criteria, 161 patients completed the baseline cognitive assessment, and 138 completed the comprehensive cognitive assessment in 3-6 months after stroke.Logistic regression analysis showed that 3 weeks baseline cognitive status was an independent factor affecting memory (P<0.05, OR=62.47, 95%CI=13.00-205.00), execution (P<0.05, OR=38.29, 95%CI=8.00-170.00), language (P<0.05, OR=6.46, 95%CI=2.31-18.04) and information processing speed (P<0.05, OR=5.88, 95%CI=2.24-15.41) in 3-6 months after stroke.According to the number of impaired cognitive domains, the overall cognitive function was defined.There were 61 cases of no or mild cognitive dysfunction group and 77 cases of moderate or severe cognitive impairment group.Multifactor logistic analysis showed that baseline cognitive status was independent of the overall cognitive function of 3-6 months after apoplexy adjusting for the age and education level (P<0.05, OR=25.32, 95%CI=7.52-85.39). Conclusion Short cognitive assessment in early apoplexy can predict the short-term functional status of cognitive domains such as memory, execution, language and information processing speed after stroke, and can also predict the overall cognitive level. Key words: Ischemic stroke; Cognitive assessment; Post-stroke cognitive impairment

Objective — to analyze the results of screening for post‑stroke cognitive impairment (PCI) in patients with cerebral stroke (CS) admitted to the Stroke Center (SC) in different disease phases, and to determine independent predictors of the PCI persistence at discharge.&#x0D; Methods and subjects. 399 patients were enrolled, including 242 (60.7 %) men and 157 (39.3 %) women with the median age was 66.2 years (IQR 58.5 — 76.3). IS was diagnosed in 331 (82.9 %), and ICH in 68 (17.1 %) patients. Among patients with IS, 137 (41.4 %) had an atherothrombotic subtype, 152 (46.0 %) had a cardioembolic subtype, 21 (6.3 %) had a lacunar subtype, another 21 (6.3 %) had another or unknown cause of stroke. Patients were screened for PCI using the Mini‑Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) on admission and at discharge. Participants with MMSE score of 0 — 24 or a MoCA score of 0 — 25 were considered having PCI. Upon admission, all patients were assessed using the National Institutes of Health Stroke Scale (NIHSS), Bartel Index, and Modified Rankine Scale (mRS). The method of constructing and analyzing logistic regression models was used to determine independent predictors of the preservation of PCI at discharge. The analysis was carried out using the MedCalc v. 19.1.&#x0D; Results. The baseline NIHSS score ranged from 0 to 39 (median 11, IQR 6 — 18). The majority (64.2 %) of the subjects were hospitalized within the first 30 days from the CS onset. The MMSE score on admission ranged from 0 to 30 (median 20, IQR 2 — 27), and in 179 (44.9 %) of the patients the initial score was 0 to 17 (severe PCI), whereas in 61 (15 3 %) of the participants it was 18 to 24 (moderately severe PCI) and only 159 (39.8 %) persons scored 25 to 30 (no PCI). The baseline MoCA score ranged from 0 to 30 (median 15, IQR 1 — 24), and 356 (89.2 %) patients were shown to have PCI (score 0 to 25). According to screening with MMSE at discharge, 125 (31.4 %) patients had severe PCI, and 67 (16.8 %) had moderately severe PCI. The MoCA assessment before discharge indicated PCI in 324 (81.2 %) patients. According to both MMSE and MoCA, the rate of PCI on admission was significantly higher than at discharge (p &lt; 0.001). Among the 240 patients who had PCI according to MMSE score, 239 (99.6 %) had PCI according to the MoCA score. However, among 159 patients who screened negative for PCI with MMSE at admission, 117 (73.6 %) screened positive with MoCA. Screening results using both MMSE and MoCA were not significantly associated with affected hemisphere. ICH was associated with lower (p &lt; 0.0001) MMSE and MoCA scores compared with IS. Predictors of PCI according to MMSE score at discharge were a longer time interval from CS onset to SC admission, and a lower baseline MMSE score. However, with MoCA, the predictors were AT subtype IS, lesions in the distribution of the right or both middle cerebral arteries, older patient age, and a lower baseline MoCA score.&#x0D; Conclusions. In patients with MI, a high rate of PCI was documented on admission, but was significantly lower at discharge. In patients with established PCI, according to MMSE score, the use of MoCA for screening seems useless, however, screening with MoCA identified PCI in 3/4 in patients with a normal MMSE score. The independent predictors of scores on these two scales, indicating PCI, were significantly different, so they should not be considered interchangeable.

The cognitive level of post-stroke aphasia (PSA) patients is generally lower than non-aphasia patients, and cognitive impairment (CI) affects the outcome of stroke. However, for different types of PSA, what kind of cognitive assessment methods to choose is not completely clear. We investigated the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and the Non-language-based Cognitive Assessment (NLCA) to observe the evaluation effect of CI in patients with fluent aphasia (FA) and non-fluent aphasia (NFA). 92 stroke patients were included in this study. Demographic and clinical data of the stroke group were documented. The language and cognition were evaluated by Western Aphasia Battery (WAB), MoCA, MMSE, and NLCA. PSA were divided into FA and NFA according to the Chinese aphasia fluency characteristic scale. Pearson's product-moment correlation coefficient test and multiple linear regression analysis were performed to explore the relationship between the sub-items of WAB and cognitive scores. The classification rate of CI was tested by Pearson's Chi-square test or Fisher's exact test. The scores of aphasia quotient (AQ), MoCA, MMSE, and NLCA in NFA were lower than FA. AQ was positively correlated with MoCA, MMSE, and NLCA scores. Stepwise multiple linear regression analysis suggested that naming explained 70.7% of variance of MoCA and 79.9% of variance of MMSE; comprehension explained 46.7% of variance of NLCA. In the same type of PSA, there was no significant difference in the classification rate. The classification rate of CI in NFA by MoCA and MMSE was higher than that in FA. There was no significant difference in the classification rate of CI between FA and NFA by NLCA. MoCA, MMSE, and NLCA can be applied in FA. NLCA is recommended for NFA.

The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are low costing and noninvasive neuropsychological tests in screening Mild Cognitive Impairment (MCI) due to Alzheimer's disease (AD). There is no consensus on which test performs better in detecting MCI due to AD based on the different imperfect reference standards. Therefore, we conducted a meta-analysis to assess the diagnostic performance of MMSE and MoCA for screening MCI due to AD in the absence of a gold standard. Six electronic databases were searched for relevant studies until April, 2022. A hierarchical Bayesian latent class model was used to estimate the pooled sensitivity and specificity of MoCA and MMSE in the absence of a gold standard. 90 eligible studies covering 21273 individuals for MMSE, 26631 individuals for MoCA were included in this meta-analysis. The pooled sensitivity was 0.71(95%CI: 0.67-0.74) for MMSE and 0.85(95%CI: 0.83-0.88) for MoCA, while the pooled specificity was 0.71(95%CI: 0.68-0.74) for MMSE and 0.79(95%CI: 0.76-0.81) for MoCA. MoCA was useful to "rule in" and "rule out" the diagnosis of MCI due to AD with higher positive likelihood ratio (4.07; 95%CI: 3.60-4.62) and lower negative likelihood ratio (0.18; 95%CI: 0.16-0.22). Moreover, the diagnostic odds ratio of MoCA was 22.08(95%CI: 17.24-28.29), which showed significantly favorable diagnostic performance. It suggests that MoCA has greater diagnostic performance than MMSE for differentiating MCI due to AD when the gold standard is absent. However, these results should be taken with caution given the heterogeneity observed.

Introduction: Post-stroke cognitive impairment (PSCI) has a considerable impact on patients and society. However, the characteristics and prevalence of long-term PSCI may be influenced by assessment methods and selection bias. We therefore used two cognitive screening methods to assess PSCI in ten-year stroke survivors, made comparisons with non-stroke individuals, and compared these screening methods. Methods: The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered and compared in a population-based consecutive sample of ten-year stroke survivors. In addition, age- and sex-matched non-stroke controls were assessed with the MMSE. Regression analyses adjusting for education compared the stroke survivors’ MMSE performance with the controls. Moderate/severe cognitive impairment, approximating to dementia, was defined using MMSE&lt;24 and MoCA&lt;20 as cut-offs. To detect those with mild cognitive impairment, alternative cut-offs of MMSE&lt;27 and MoCA&lt;25 were also used. Results: In total, 127 of 145 stroke survivors participated. The total MMSE-scores were similar for stroke survivors (median 27) and 354 controls (median 27; p =0.922); as well as proportions with MMSE&lt;24 (23% vs. 17%; p =0.175) or MMSE&lt;27 (47% vs. 49%; p =0.671). After adjustment for education, stroke survivors showed an increased risk for moderate/severe cognitive impairment defined by MMSE&lt;24 (OR=1.82; p =0.036). Executive dysfunction was seen in 42% of the stroke survivors vs. 16% of the controls as evaluated by MMSE ( p &lt;0.001). According to MoCA, moderate/severe cognitive impairment (MoCA&lt;20) was observed in 28% of the stroke survivors; any degree of cognitive impairment (MoCA&lt;25) was seen in 61%; and 45-61% displayed executive function deficits. Conclusions: PSCI including executive dysfunction is common among ten-year stroke survivors, who have an increased risk of moderate/severe cognitive impairment compared to non-stroke controls. The prevalence of long-term PSCI may have been previously underestimated, and MoCA may be more suitable for post-stroke cognitive assessment.

Objective To compare the applicability of the Beijing Version of the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) in screening for cognitive impairment in patients with acute ischemic stroke for 2-3 weeks. Methods MoCA and MMSE were conducted in 201 patients with acute ischemic stroke within 2 to 3 weeks after the onset of stroke. With MoCA<23 and MMSE<26 as the cut off value, we assessed the clinic effect of the MoCA and MMSE and explored the correlation between two instruments. Results The average scores of MoCA and MMSE scale were (20.5±4.3) and (25.4±3.5) points. The prevalence of cognitive impairment evaluated with MoCA and MMSE were 57.2% and 43.3%, respectively.MoCA showed significant correlation with MMSE score (Pearson's correlation coefficient=0.833, P<0.001), and an agreement with Kappa values of 0.532 (P<0.01) in screening for cognitive impairment. Conclusions The prevalence of cognitive impairment assessed with MoCA is higher than that of with MMSE when using MoCA<23 and MMSE<26 as the cut off values. Both instruments show a good agreement for screening cognitive impairment in acute ischemic stroke within 2 to 3 weeks following the disease onset. Key words: Acute ischemic stroke; Cognitive impairment; Montreal Cognitive Assessment (MoCA); Mini Mental State Examination (MMSE)

Background/Introduction Atrial fibrillation (AF) is sometimes detected when thromboembolic events occur, commonly ischaemic stroke (IS). In patients with AF, the prevalence of cognitive dysfunction (CD) is higher, independently from IS. Purpose Evaluating the usefulness of cognitive evaluation and the CHA2DS2-VASc score for the prediction of documented AF and IS. Methods In this cross-sectional retrospective study, we included 469 patients with cardiovascular diseases. Between December 2016 and November 2019, all patients completed two cognitive tests during hospitalization. The Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) were used. The associations between cognitive test scores (standard and optimal cut-off values) and AF/IS were analyzed by logistic regression. We determined the area under the curve (AUC) of CD tests and optimal cut-off values using the receiver operating characteristic curves and the maximum Youden index. Results We found a significant association between the standard MoCA cut-off value for CD (&amp;lt;26 points) and the presence of documented AF (OR: 1.83, 95% CI: 1.11-3.01, p= 0.0174) and IS (OR: 2.09, 95% CI: 1.04-4.22, p= 0.0379). The standard MMSE score of &amp;lt;24 points was a risk factor for the presence of a previous IS (OR: 2.43, 95% CI: 1.3-4.53, p= 0.0051). For the prediction of documented AF, the optimal cut-off score was &amp;lt;26 for MoCA and &amp;lt;28 points for MMSE. For MoCA, the optimal cut-off was &amp;lt;23 points in the prediction of IS and &amp;lt;28 points for MMSE. The determined CHA2DS2-VASc cut-off score for AF was &amp;gt;3 points and for IS &amp;gt;5 points. The receiver operating characteristic curve analyses showed non-inferiority between CD tests and CHA2DS2-VASc score in anticipating documented episodes of AF and were superior to CHA2DS2-VASc score in the prediction of a previous IS (MoCA: AUC dif: 0.128; p= 0.0110, MMSE: AUC dif: 0.130, p= 0.0084). Conclusions In this study, we demonstrated that the MoCA and MMSE tests can detect the presence of documented AF and IS. Risk factors for AF were MoCA &amp;lt;26 points and MMSE &amp;lt;28 points while for IS MoCA &amp;lt;23 points and MMSE &amp;lt;28 points. In patients who present cognitive impairment AF screening may be appropriate.

Objective:To assess the utility of the Mini Mental State Exam (MMSE) and Montreal Cognitive Assessment (MoCA) for tracking cognitive changes Huntington’s Disease.Participants and Methods:Currently, the most frequently used brief assessment of global cognitive functioning is the MMSE. Although the MMSE is helpful for distinguishing individuals without significant cognitive impairment from those with dementia, it is not particularly sensitive to more subtle cognitive deficits. The MoCA is another brief cognitive screening tool that has been shown to be more sensitive to mild impairment and may have greater usefulness in subcortical dementias because of its more extensive assessment of executive function. Although the MoCA appears to have high sensitivity and specificity in a variety of neurological populations, there is currently little known about its efficacy in tracking cognitive decline in individuals with HD. We used a mixed effects model to analyze MMSE and MoCA scores collected prospectively during 5 years of follow-up for 163 patients with HD seen at one academic HDSA Center of Excellence. Baseline mean age for the HD cohort was 51.35 years, mean education 14.46 years, and a mean CAG repeat length 43.95. Mean follow-up time was 3.33 years.Results:Mean MMSE and MoCA scores at baseline were 25.13 (SD=1.66) and 22.76 (SD=3.70) respectively. At baseline, age and gender were not associated with MMSE and MoCA scores, while years of education were. Neither age nor gender predicted rate of decline for the MoCA while years of education predicted rate of decline for the MMSE. For the MMSE, each year of education predicted on average 0.51 points higher score at enrollment; for the MoCA, each year of education predicted on average 0.79 points higher score at enrollment. The mean rates of decline on the MMSE was 0.48 points per year (p&lt;.001) while that on the MoCA was only 0.31 points annually (p&lt;.001) in the first five years of observation.Conclusions:The MMSE and MoCA decline significantly over time in an unselected HD population. The smaller rate of decline in the MoCA may be due, in part, to the greater variability in baseline, MoCA (SD=3.70) vs MMSE (SD=1.66) scores in our HD cohort. Unlike cortical dementias, such as Alzheimer’s disease (AD), where declines of 2-3 points per year have been described for the MMSE and MoCA, much lower annual rates of decline have been reported in subcortical dementias such as Parkinson’s disease. To our knowledge, this is the first report of rate of cognitive decline on the MMSE and MoCA in HD: such information is vital for adequately preparing patients and families for future needs, in addition to planning for interventional/treatment trials in HD.

Objective To evaluate the Montreal cognitive assessment (MoCA) for detecting the mild cognitive impairment (MCI) in brain trauma patients with normal mini-mental state examination (MMSE) scores. Methods Fifty brain trauma patients with normal MMSE scores hospitalized from January 2013 to June 2014 were subjected to the MoCA test. The patients were classified as cognitive impairment group scored less than 26 on the MoCA and cognitive normal group scored 26 or above on the MoCA. Differences in MMSE and MoCA scores of the two groups were compared. Receiver operative characteristic (ROC) curve was used to determine the optimal cut-off scores in screening for MCI. Results Overall MMSE and MoCA scores were (27.84±0.89)points and (23.24±2.90)points. There was a positive correlation between MoCA and MMSE total scores (r=0.355 2, P<0.05). MCI was found in 79% of the brain trauma patients using the MoCA. MMSE total score and subscores were all similar between the two groups. MoCA total score and subscores of attention, language, abstraction and delayed recall were much higher in cognitive normal group than in cognitive impairment group (P<0.05), but there were no significant differences in visuospatial, naming and oritention domains. Area under the ROC curve for MoCA(0.871±0.038) was larger compared with MMSE (0.796±0.054) (Z=3.592, P<0.05). The optimal cut-off scores of MoCA and MMSE for the identification of MCI were 25.5 and 28.5 respectively. Conclusions MoCA and MMSE total scores are positively correlated. MoCA is a better detector for the identification of MCI in brain trauma patients than the MMSE. Key words: Craniocerebral trauma; Cognition disorders; Montreal cognitive assessment/mini-mental state examination

Objective To compare the effects of carotid endarterectomy (CEA) and carotid artery stenting (CAS) on cognitive function in patients with severe carotid artery stenosis. Methods Two hundreds and sixteen severe carotid artery stenosis patients comprising 70 patients with CEA, 76 patients with CAS and 70 controls were recruited consecutively. All of them were subject to the cognitive assessment including Mini-mental State Examination (MMSE), the Chinese version Montreal Cognitive Assessment (MoCA) and event related potential P300 pre- and post-treatment for 3 months. Results During the 3-month follow-up period, patients who underwent CEA(MMSE: 27.10±1.62, MoCA: 24.16±1.81) or CAS (MMSE: 26.70±1.52, MoCA: 23.58±1.78)exhibited significant improvements in cognitive function compared with pre-treatment(MMSE: 26.31±1.38, MoCA: 23.21±1.39; MMSE: 25.95±1.44, MoCA: 22.85±1.51; all P=0.000). It did not show significant difference in the control group when comparing the pre- with the post-treatment. The improvement in MoCA score and reduction in P300 (ms)incubation in CEA(0.94±0.90, 22.09±21.85)seemed more obvious than those in CAS(0.73±0.78, 18.80±25.41), although the difference was not statistically significant. Conclusion The findings of this study suggest that both CEA and CAS have a significant effect on cognitive function in patients with severe carotid artery stenosis. Key words: Carotid stenosis; Endarterectomy, carotid; Stents; Cognition disorders; Neuropsychological tests

Feasibility of the Cognitive Assessment scale for Stroke Patients (CASP) vs. MMSE and MoCA in aphasic left hemispheric stroke patients

Objective To compare the accuracy,sensitivity,specificity of the Mini-Mental State Examination (MMSE) and Montreal cognitive assessment (MoCA) in screening of mild cognitive impairment(MCI) and dementia in community survey. Methods This study was conducted among residents aged 65 years and above in the urban and rural areas selected by stratified sampling from 6 urban and 2 rural communities.The 2 111 cases who finished the Neuropsychological tests included MMSE,MoCA,and Clinical Dementia Rating scale(CDR) were divided into groups normal control,MCI,and dementia.The accuracy,sensitivity and specificity was compared by the area under the curve (AUC) of receiver-operating characteristic curve.The clinical diagnoses of MCI was made according to Petersen′s criteria. Results The areas under curve were between 0.72 to 0.99 for MMSE and MoCA on discriminated MCI or dementia (Z=2.75，P 0.05). In MCI survey,the cutoff values and sensitivity/specificity of MMSE vs.MoCA in education levels of illiterate,primary,secondary and above were 21(84%/64%) vs.15(88%/54%),26(91%/70%) vs.20(94%/68%),27(93%/86%) vs.23(93%/80%) respectively;but in dementia survey,the cutoff values and sensitivity/specificity of MMSE vs. MoCA in education levels of illiterate,primary,secondary and above were 16(98%/85%) vs.11(98%/70%),20(100%/94%) vs.14(100%/87%),22(100%/98%) vs.16(100%/95%) respectively. Conclusions MMSE and MoCA are good cognitive assessment tools in the survey of MCI or dementia with high accuracy,sensitivity and specificity.But the cutoff value is different according to one′s education level.MoCA may be more suitable for MCI survey but MMSE for dementia. Key words: Cognition disorders; Dementia; Mini-Mental State Examination; Montreal cognitive assessment