PP.34.06

Abstract

Objective: Cognitive impairment is associated with compliance issues and worse outcomes in patients with chronic diseases. Most guidelines recommend using the Mini Mental State Examination (MMSE) to screen for cognitive impairment in older hypertensive patients. The aim of this study was to compare the yield of the MMSE and of the Montreal Cognitive Assessment (MoCA), a screening test known to be more sensitive for vascular dementia and mild cognitive impairment (TCL), in older outpatients at high cardiovascular risk. Design and method: Independently living patients over 65 who were prescribed a treatment for cardiovascular prevention and followed-up by their general practitioner were recruited in a health center. Each patient was randomly assigned to undergo either the MMSE or the MoCA. A MMSE score < 27 (or 24 if high school was not completed) or MoCA score < 26 (25 if high school was not completed) was considered as indicating cognitive impairment. The physician judgement regarding the cognitive ability of each patient was recorded, blind to test results. Results: Patients randomized to the MMSE (n = 55) were similar to those randomized to the MoCA (n = 56, Table). Assessment lasted a little more than 10 min with both tests (Table). There were 22 (40%) screen positive patients with the MMSE and 38 (68%) with the MoCA (p < 0.004 for the difference). Physicians’ judgements predicted a positive MMSE with 97% specificity but only 9% sensitivity, a positive MoCA with 94% specificity but only 16% sensitivity.Conclusions: Cognitive impairment is very frequent in patients over 65 years treated for cardiovascular prevention in primary care, and largely unrecognized by physicians despite its wide ranging consequences including therapeutic non-compliance. Screening guidelines should promote use of the MoCA rather than the MMSE in these patients, since it is able to better detect vascular dementia and mild cognitive impairment with a similar screening time.