Montreal Cognitive Assessment Subtests Research Articles

Improving diagnostic accuracy of the Montreal Cognitive Assessment to identify post-stroke cognitive impairment

Given advantages in reperfusion therapy leading to mild stroke, less apparent cognitive deficits can be overseen in a routine neurological examination. Despite the widespread use of the Montreal Cognitive Assessment (MoCA), age- and education-specific cutoffs for the detection of post-stroke cognitive impairment (PSCI) are not established, hampering its valid application in stroke. We aimed to establish age- and education-specific MoCA cutoffs to better discriminate patients with and without acute PSCI. Patients with acute ischemic stroke underwent the MoCA and a detailed neuropsychological assessment. PSCI was defined as a performance < − 1.5 SD in ≥ 2 cognitive domains. As secondary data analysis, the discriminant abilities of the MoCAraw-score (not adding + 1 as correction for ≤ 12 years of education, YoE) cutoffs were automatically derived based on Youden Index and evaluated by receiver operating characteristic analyses across age- (< 55, 55–70, > 70 years old) and education-specific (≤ 12 and > 12 YoE) groups. 351 stroke patients (67.4 ± 14.1 years old; 13.1 ± 2.8 YoE) underwent the neuropsychological assessment 2.7 ± 2.0 days post-stroke. The original MoCA cutoff < 26 falsely classified 26.2% of examined patients, with poor sensitivity in younger adults (34.8% in patients < 55 years > 12 YoE) and poor specificity in older adults (55.0%, in > 70 years ≤ 12 YoE). By maximizing both sensitivity and specificity, the optimal MoCAraw cutoffs were: (i) < 28 in patients aged < 55 with > 12 YoE (sensitivity = 69.6%, specificity = 77.8%); (ii) < 22 and < 25 in patients > 70 years with ≤ 12 and > 12 YoE (sensitivity = 61.6%, specificity = 90.0%; sensitivity = 63.3%, specificity = 84.0%, respectively). In other groups the optimal MoCAraw cutoff was < 26. Age and education level should be considered when interpreting MoCA-scores. Though new age- and education-specific cutoffs demonstrated higher discriminant ability for PSCI, their performance in young stroke and adults with higher education level was low due to ceiling effects and MoCA subtests structure, and cautious interpretation in these patients is warranted.Trial registration: ClinicalTrials.gov Identifier: NCT05653141.

Comparing the Effect of Repetitive Transcranial Magnetic Stimulation Therapy and Aerobic Exercise as an Add-on Therapy on the Cognitive Function of Patients with Depression

Background: Cognitive disturbances are a major cause of disability in depression. The antidepressant medication effectively improves cognitive function. However, its adverse effect limits its use, so add-on treatment is needed to support its effectiveness. Aim: This study aims to compare the efficacy of aerobic exercise and repetitive transcranial magnetic stimulation (rTMS) as an add-on treatment for improving cognitive function. Material and Methods: Twenty-seven patients with first episodes of moderate and severe depression were recruited from the outpatient psychiatry clinic to join this randomized controlled trial. Participants were allocated to three groups: antidepressant only, antidepressant with add-on aerobic exercise, and antidepressant with add-on rTMS therapy. All participants received 2 weeks of intervention. Cognitive functions were assessed using Montreal Cognitive Assessment (MOCA). Results: No differences were found in baseline characteristic data between groups. Total MOCA score increased after intervention in a group with no add-on treatment (p=0.007), with add-on aerobic exercise (p=0.011), and with add-on rTMS therapy (p=0.017). Hence, there was no between-group difference (p=0.222). The MOCA subtest analysis revealed between-group differences in changes in delayed recall subtest score (p=0.01). The group with add-on rTMS therapy improved better than the group with antidepressants only (p=0.005). Conclusion: The addition of rTMS therapy resulted in better improved delayed recall function than the addition of aerobic exercise or without any add-on treatment. This finding supports the application of rTMS therapy as an add-on treatment to improve the cognitive function of patients with depression.

Cognitive impairment in patients of cardiac surgery with senile asthenia syndrome and preastenia

To identify the features of the cognitive status in patients with cardiac surgery profile with senile asthenia syndrome (SAS) and preasthenia. A study included 272 patients admitted for coronary artery bypass grafting (CABG). Screening for preasthenia and SAS in patients before surgery was performed using the Brief Battery of Physical Functioning Tests. SAS and preasthenia were detected in 15% of patients (n=41). Seventy-five patients were selected in the comparison group without asthenia. Assessment of the state of cognitive functions was carried out using screening neuropsychological scales - the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The median of the MMSE score (27 [26; 28] and 28 [27; 29], p=0.04), and the MoCA score (23 [19; 25] and 25 [23; 27], p=0.0085) was significantly lower in patients with asthenia and pre-asthenia compared to patients without asthenia. According to the MoCA, about 60% of patients in the pre-asthenia-asthenia group had severe cognitive impairment, while in the group without asthenia, more than 30% of cases had normal cognitive functions (p=0.003). Significant intergroup differences were found in MoCA subtests, reflecting visuospatial skills, abstraction, verbal fluency and working memory (p=0.01-0.04). Regression analysis showed that age and physical functioning index (severity of asthenia) most significantly contributed to the basic cognitive status assessed by MoCA. Features of the cognitive status in patients of cardiac surgery with the SAS and preasthenia are impairments of visuospatial thinking, verbal fluency, abstract thinking and working memory. The MoCA was shown to be informative in determining the basic cognitive status of cardiac surgical patients. At the same time, the greatest contribution to the basic cognitive status is made by age and the indicator of physical functioning, which characterizes the degree of asthenia.

Extra-Linguistic Cognitive Functions Involved in the Token Test: Results from a Cohort of Non-Aphasic Stroke Patients with Right Hemisphere Lesion.

The Token Test (TT) is widely used to examine comprehension disorders in aphasic patients, but abilities other than language may affect a patient's performance. This study aims to explore the correlation between the TT subtest performances and the performances in extra-linguistic cognitive areas in a cohort of patients from the Intensive Rehabilitation Post-Stroke (RIPS) study with a first, right hemisphere stroke and without aphasia, prospectively enrolled at admission to intensive inpatient post-acute rehabilitation. The patients were administered the TT (50-item version), the forward and backward digit span (DST), and the Montreal Cognitive Assessment (MoCA). Spearman's partial correlations adjusted by age were used to evaluate the association between the number of errors in the TT and the other tests' corrected scores. Of the 37 patients enrolled in this study, 29.7% made 3-11 errors on the TT, 27.0% more than 11 errors, mostly in parts IV and V. The forward and backward digit span scores showed correlations with errors in part V of the TT (r = -0.408, p = 0.013; r = -0.307, p = 0.027). The errors in part IV of the TT presented a correlation with a forward digit span too (r = -0.394, p = 0.017). With respect to MoCA domains, executive functioning, and orientation were related to the TT part V errors (r = -0.468, p = 0.007; r = -0.499, p = 0.003). The orientation also correlated with the TT part III (r = -0.504, p = 0.002). Our findings show that the TT performances in patients with right hemisphere stroke and without aphasia are related to impairments in auditory-verbal span/auditory working memory mostly for TT scores on subpart V as measured by the DST and to executive function and orientation, as measured by the MoCA subtests.

Association of Anxiety and Depression with Objective and Subjective Cognitive Decline in Outpatient Healthcare Consumers with COVID-19: А Cross-Sectional Study.

In addition to the neurological complications affecting people infected with COVID-19, cognitive impairment symptoms and symptoms of anxiety and depression remain a frequent cause of complaints. The specificity of cognitive impairment in patients with COVID-19 is still poorly understood. An exploratory study of factors that may be associated with cognitive decline during the COVID-19 pandemic. The cross-sectional multicentre observational study was conducted in a polyclinic unit in Saint Petersburg and in the regions of the North-Western Federal Region. During the study, socio-demographic parameters and information about the somatic condition of patients who applied for primary health care was collected. Emotional and cognitive state were investigated using the Hospital Anxiety and Depression Scale (HADS) and Montreal Cognitive Assessment (MoCA). Mathematical and statistical data processing was carried out using SPSS and RStudio statistical programs. The study included 515 participants, 60% (n=310) of which were women. The sample was divided into those who did (28.5%, n=147) and did not (71.4%, n=368) complain of cognitive decline. Patients with complaints of cognitive decline were significantly older, had lower levels of education and higher levels of depression and anxiety according to HADS (p <0.05). Patients with complaints of cognitive decline underwent the MoCA test (24.3%, n=125). The median MoCA test scores were within the normal range (Median=27, Q1=25, Q3=28), and cognitive decline (MoCA less than 26 points) was detected in 40% (n=50) of patients with complaints of cognitive decline. No significant correlations were found between the MoCA scores and the levels of anxiety and depression according to the HADS (p >0.05). Patients with mild severity of the COVID-19 course were more successful with MoCA subtests than patients with moderate and severe courses. We found no linear association between objective cognitive deficit and the affective state of respondents. Patients' subjective complaints about cognitive dysfunction were mostly caused by their emotional state than an objective decrease of their cognitive functions. Therefore, in case of subjective complaints on cognitive decline, it is necessary to assess not only the cognitive but also the affective state of the patient. The severity of the COVID-19 course affects the functions of the cognitive sphere, including attention, regulatory functions and speech fluency. Mild and moderate severity of the COVID-19 correlates with clinically determined depression. The absence of this relationship with the severe course of the disease is probably explained by the significant somatic decompensation of patients.

Factors that contribute to the cognitive impairment in elderly dialysis patients.

To evaluate the cognitive function in dialysis patients over 60 years old and identify the contributing factors. A group of elderly dialysis patients in the Department of Nephrology, Pan'an People's Hospital between March 2015 and June 2018 were chosen as the subjects for this study. Patients were divided into two groups, those with cognitive impairment and those with normal cognitive function. Results of their Montreal Cognitive Assessment (MoCA) scores, Controlled Oral Word Association Test (COWAT), Wechsler Adult Intelligence Scale Digit Span subtest (WDMS), and Stanford Diagnostic Math Test (SDMT) were reviewed and analyzed. Among the 110 elderly dialysis patients, 75 patients (68.18%) showed different levels of damage to their cognitive function. Their assessment scores on MoCA (total), MoCA subtests: visuospatial/executive, naming, attention, language, delayed recall, abstraction and orientation, COWAT (total), COWAT1, COWAT2, COWAT3, WMDS-Backward, and SDMT are significantly lower than patients with normal cognitive abilities (p< 0.05). Further analysis showed that the highest percentage (72.00%) of patients had impairment with visuospatial/executive function; and, of the 75 cognitive impaired patients, 37.33% showed cognitive damage in two MoCA subtests simultaneously. Patients with and without cognitive impairment showed a significant (p< 0.05) difference on factors including age, education level, employment status, financial situation, dialysis vintage, serum albumin, and hemoglobin. Elderly patients on dialysis have a higher risk of becoming cognitive impaired. The cognitive impairment in elderly dialysis patients was significantly associated with age, dialysis vintage, and levels of serum albumin and hemoglobin.

A-16 MoCA Subtest Analysis: Discriminating between Healthy Controls and MCI

Abstract Objective The Montreal Cognitive Assessment (MoCA) is a suitable, sensitive, and specific cognitive screener for detecting mild cognitive impairment (MCI). Previous research has found markers to discriminate between healthy controls and MCI on MoCA subtest scores. Specifically, MCI performed worse on executive functioning and attention tasks (i.e., inverse digits, serial 7’s, repetition, fluency, abstraction, and word recall). The aim of the present study is to assess for discrimination patterns in MoCA performance between healthy controls and MCI. Method Data was collected through the National Alzheimer’s Coordinating Center (NACC). A sample of healthy controls (n = 3776, 65% female, 80% White, 17% Black, 3% Asian/Pacific Islander) and MCI (n = 1143; 51% female, 82% White, 15% Black, 3% Asian/Pacific Islander) were examined. Results An initial independent t-test revealed a statistically significant difference in MoCA scores for healthy controls (M = 26.18, SD = 2.78) and MCI (M = 22.01, SD = 3.49; t(4917) = 36.91, p = 0.000, Cohen’s d = 1.32). Additional t-tests were performed to compare MoCA subtest scores and domain scores for diagnostic groups. There was a statistically significant difference for healthy controls and MCI groups across all MoCA subtests and domains. Further examination using normal distribution revealed worse performance on cube copy and word recall in MCI groups. Conclusions Consistent with previous findings, word recall was able to discriminate between healthy controls and MCI. However, this study was able to find discrimination in cube copy performance. These findings may guide clinicians to use these interval changes as early cognitive markers for impairment, allowing for early detection and intervention.

A-7 Discriminating between Mild Cognitive Impairment and Alzheimer’s Disease on the MoCA

Abstract Objective The Montreal Cognitive Assessment (MoCA) is a suitable, sensitive, and specific cognitive screener for detecting mild cognitive impairment (MCI). Previous research has found markers to discriminate between MCI and Alzheimer’s disease (ad) on MoCA subtest scores. Specifically, impaired performance on the clock drawing (i.e., number and hand placement), rhino naming, serial 7’s, word recall, and orientation were suggestive of ad. The aim of the present study is to assess for discrimination patterns in MoCA performance between MCI and ad.Method: Data was collected through the National Alzheimer’s Coordinating Center (NACC). A sample of MCI (n = 1143; 51% female, 82% White, 15% Black, 3% Asian/Pacific Islander) and ad groups (n = 1339; 56% female, 89% White, 9% Black, 2% Asian/Pacific Islander) were examined. Results An initial independent t-test revealed a statistically significant difference in MoCA scores for MCI (M = 22.01, SD = 3.49) and ad (M = 14.46, SD = 6.05; t(2480) = 38.72, p = 0.000, Cohen’s d = 1.53). Additional t-tests were performed to compare MoCA subtest scores and domain scores for diagnostic groups. There was a statistically significant difference for MCI and ad groups across all MoCA subtests and domains. Despite no discrimination in profiles noted on t-tests, further examination using normal distribution revealed worse performance on trails, clock hands, serial 7’s, repetition, fluency, date, and place in ad groups. Conclusions Consistent with previous findings, clock hands, serial 7’s, and orientation were able to discriminate between ad and MCI. This study found further discrimination in trails, repetition, and fluency. These findings may allow for clinicians to use these patterns of performance as early cognitive markers of impairment.

A Spanish Neuropsychological Battery Discriminates Between the Behavioral Variant of Frontotemporal Dementia and Primary Progressive Aphasia in a Colombian Sample.

The differential diagnosis among the behavioral variant of frontotemporal dementia FTD (bvFTD) and the linguist one primary progressive aphasia (PPA) is challenging. Presentations of dementia type or variants dominated by personality change or aphasia are frequently misinterpreted as psychiatric illness, stroke, or other conditions. Therefore, it is important to identify cognitive tests that can distinguish the distinct FTD variants to reduce misdiagnosis and best tailor interventions. We aim to examine the discriminative capacity of the most frequently used cognitive tests in their Spanish version for the context of dementia evaluation as well as the qualitative aspects of the neuropsychological performance such as the frequency and type of errors, perseverations, and false positives that can best discriminate between bvFTD and PPA. We also described mood and behavioral profiles of participants with mild to moderate probable bvFTD and PPA. A total of 55 subjects were included in this cross-sectional study: 20 with PPA and 35 with bvFTD. All participants underwent standard dementia screening that included a medical history and physical examination, brain MRI, a semistructured caregiver interview, and neuropsychological testing. We found that bvFTD patients had worse performance in executive function tests, and the PPA presented with the lower performance in language tests and the global score of Mini-Mental State Examination (MMSE). After running the linear discriminant model, we found three functions of cognitive test and subtests combination and three functions made by the Montreal Cognitive Assessment (MoCA) language subtest and performance errors that predicted group belonging. Those functions were more capable to classify bvFTD cases rather than PPA. In conclusion, our study supports that the combination of an individual test of executive function and language, MoCA's subtest, and performance errors as well have good accuracy to discriminate between bvFTD and PPA.

Cognitive and Emotional Disturbances Due to COVID-19: An Exploratory Study in the Rehabilitation Setting.

The coronavirus disease 19 (COVID-19) can cause neurological, psychiatric, psychological, and psychosocial impairments. Literature regarding cognitive impact of COVID-19 is still limited. The aim of this study was to evaluate cognitive deficits and emotional distress among COVID-19 and post–COVID-19 patients who required functional rehabilitation. Specifically, this study explored and compared cognitive and psychological status of patients in the subacute phase of the disease (COVID-19 group) and patients in the postillness period (post–COVID-19 group). Forty patients admitted to rehabilitation units were enrolled in the study and divided into two groups according to the phase of the disease: (a) COVID-19 group (n = 20) and (b) post–COVID-19 group (n = 20). All patients underwent a neuropsychological assessment including Mini-Mental State Evaluation (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Rating Scale for Depression, and Impact of Event Scale–Revised (IES-R). A larger part of the COVID group showed neuropsychological deficits in the total MMSE (35%) compared to the post-COVID group (5%), whereas the majority of both groups (75–70%) reported cognitive impairments in the total MoCA. The post-COVID group reported significantly higher score in MMSE subtests of language (p = 0.02) and in MoCA subtests of executive functions (p = 0.05), language (p = 0.01), and abstraction (p = 0.02) compared to the COVID group. Regarding emotional disturbances, ~40% of patients presented with mild to moderate depression (57.9–60%). The post–COVID-19 group reported significantly higher levels of distress at the IES-R compared to the COVID group (p = 0.02). These findings highlight the gravity of neuropsychological and psychological symptoms that can be induced by COVID-19 infection and the need for tailored rehabilitation, including cognitive training and psychological support.

Underestimation of Cognitive Impairment in Older Inpatients by the Abbreviated Mental Test Score versus the Montreal Cognitive Assessment: Cross-Sectional Observational Study

Background/Aims: Cognitive impairment is prevalent in older inpatients but may be unrecognized. Screening to identify cognitive deficits is therefore important to optimize care. The 10-point Abbreviated Mental Test Score (AMTS) is widely used in acute hospital settings but its reliability for mild versus more severe cognitive impairment is unknown. We therefore studied the AMTS versus the 30-point Montreal Cognitive Assessment (MoCA) in older (≥75 years) inpatients. Methods: The AMTS and MoCA were administered to consecutive hospitalized patients at ≥72 h after admission in a prospective observational study. MoCA testing time was recorded. Reliability of the AMTS for the reference standard defined as mild (MoCA <26) or moderate/severe (MoCA <18) cognitive impairment was assessed using the area under the receiver-operating curve (AUC). Sensitivity, specificity, positive and negative predictive values of low AMTS (<8) for cognitive impairment were determined. Results: Among 205 patients (mean/SD age = 84.9/6.3 years, 96 (46.8%) male, 74 (36.1%) dementia/delirium), mean/SD AMTS was 7.2/2.3, and mean/SD MoCA was 16.1/6.2 with mean/SD testing time = 17.9/7.2 min. 96/205 (46.8%) had low AMTS whereas 174/185 (94%) had low MoCA: 74/185 (40.0%) had mild and 100 ( 54.0%) had moderate/severe impairment. Moderate/severe cognitive impairment was more prevalent in the low versus the normal AMTS group: 74/83 (90%) versus 25/102 (25%, p < 0.0001). AUC of the AMTS for mild and moderate/severe impairment were 0.86 (95% CI = 0.80–0.93) and 0.88 (0.82–0.93), respectively. Specificity of AMTS <8 for both mild and moderate/severe cognitive impairment was high (100%, 71.5–100, and 92.7%, 84.8–97.3) but sensitivity was lower (44.8%, 37.0–52.8, and 72.8%, 62.6–81.6, respectively). The negative predictive value of AMTS <8 was therefore low for mild impairment (10.9%, 5.6–18.7) but much higher for moderate/severe impairment (75.2%, 65.7–83.3). All MoCA subtests discriminated between low and normal AMTS groups (all p < 0.0001, except p = 0.002 for repetition) but deficits in delayed recall, verbal fluency and visuo-executive function were prevalent even in the normal AMTS group. Conclusion: The AMTS is highly specific but relatively insensitive for cognitive impairment: a quarter of those with normal AMTS had moderate/severe impairment on the MoCA with widespread deficits. The AMTS cannot therefore be used as a “rule-out” test, and more detailed cognitive assessment will be required in selected patients.

Cognitive impairment in methamphetamine users with recent psychosis: A cross-sectional study in Thailand

BackgroundCognitive impairment in methamphetamine (MA) users with psychosis may be more severe than that in MA users without psychosis. This study aimed to compare the overall cognitive function and specific cognitive domains between MA users with and without psychosis. MethodsParticipants in this cross-sectional study were adult inpatients who used MA within the month prior to admission. The recent use of MA was confirmed using quantitative analysis of hair. We used the Mini International Neuropsychiatric Interview (MINI) - Plus, Psychotic Module to confirm the presence of recent psychosis in the participants who fulfilled the inclusion criteria, excluding the individuals with a lifetime history of schizophrenia. We assessed the severity of depression and MA withdrawal using the Patient Health Questionnaire (PHQ-9) and the Amphetamine Withdrawal Questionnaire. The severity of cognitive impairment was assessed using the Montreal Cognitive Assessment (MoCA). The MoCA total and subtest scores were used to compare participants with and without psychosis. ResultsParticipants included 113 MA users with psychosis and 120 MA users without psychosis. Those with psychosis had significantly lower MoCA total, visuaospatial/executive subtest, and abstract subtest scores than those without psychosis (mean differences=−0.8, −0.3, and −0.2, respectively). The association between MA psychosis and the MoCA total scores was still statistically significant after the adjustment for years in education in an ordinal logistic regression analysis. ConclusionsMA users with psychosis had poorer overall cognitive function than MA users without psychosis. The cognitive impairment is prominent in the domains of visuospatial/executive function and abstraction.

Experience with vortioxetine in the treatment of post-stroke depression

Post-stroke depression significantly impairs functional recovery in patients and their quality of life. Objective : to evaluate the efficacy of vortioxetine in correcting depressive symptoms in the early recovery period of ischemic stroke, as well as its effect on the cognitive functions of patients. Patients and methods. The investigation enrolled 60 patients with ischemic stroke in the carotid bed with symptoms of mild and moderate depression according to the Montgomery-Asberg Depression Rating Scale (MADRS). Group 1 (a study group) included 30 patients who received vortioxetine 10 mg/day for 8 weeks; Group 2 (a comparison group) consisted of 30 patients who refused to take an antidepressant. The investigators evaluated the severity of focal neurological deficit using the US National Institutes of Health Stroke Scale (NIHSS), the degree of functional deficit with the modified Rankin Scale (mRS) and the Functional Independence Measure (FIM). The diagnosis of poststroke depression was established according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria; the authors analyzed the severity of depression using the Hospital Anxiety and Depression Scale (HADS) and MADRS and cognitive functions with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). For evaluation of higher mental dysfunctions, they used a set of neuropsychological techniques developed by A.R. Luria and his followers, by applying the classic stimulus materials. Results and discussion. At 8-week follow-up, in Group 1 there were no patients with symptoms of moderate depression, only 14 (46.7%) patients had symptoms of mild depression, and the remaining 16 (53.3%) patients did not have emotional disturbances. At the same time, in Group 2, 14 (46.7%) patients were observed to have signs of moderate depressive disorder and 15 (50%) had symptoms of mild depression; 1 (0.3%) patient had symptoms of major depressive disorder. During treatment with vortioxetine, there was a considerable decrease in the severity of depressive symptoms according to the total MADRS score (U=87.0; p<0.0001) and a better functional recovery after a stroke, as shown by FIM (U=296.0, p= 0.023) and NIHSS scores (p<0.05). Analyzing the MoCA subtest scores revealed that Group 1 patients statistically significantly better coped with attention tasks (U=237.0; p<0.001). Conclusion. Vortioxetine significantly reduces the severity of depressive symptoms, has an obvious positive effect on the cognitive status of patients, by improving neurodynamic functions and memory in patients in the early recovery period of ischemic stroke.

Utility of the MoCA for cognitive impairment screening in long-term psychosis patients

Cognitive impairment is a key feature in patients with psychotic disorders. The Montreal Cognitive Assessment (MoCA) is a brief tool that has been shown to be effective in identifying mild cognitive impairment and early dementia. This study explores the usefulness of this instrument to detect cognitive impairment in long-term psychotic disorders.One hundred-forty stabilized patients were re-evaluated more than 15 years after a First Episode of Psychosis (FEP). Patients were psychopathologically assessed, and the MoCA test and MATRICS Consensus Cognitive Battery (MCCB) were administered. Two cut-off scores for cognitive impairment using the MCCB were applied (T score <40 and < 30).Concurrent validation was found between the total scores of the MoCA and MCCB. We also found significant associations between 5 out of 7 MoCA subtests (visuospatial-executive, attention, language, abstraction and delayed recall) and MCCB subtests but not for the naming and orientation MoCA subtests. Receiver operating characteristic (ROC) analysis suggested a <25 cut-off for cognitive impairment instead of the original <26.Our results suggest that the MoCA test is a useful screening instrument for assessing cognitive impairment in psychotic patients and has some advantages over other available instruments, such as its ease-of-use and short administration time.

Discriminative Ability of Montreal Cognitive Assessment Subtests and Items in Racial and Ethnic Minority Groups.

The Montreal Cognitive Assessment (MoCA) is a popular screening tool for Mild Cognitive Impairment (MCI). The psychometric properties of the MoCA have not been widely examined in minority groups. We aimed to analyze the discriminate ability of subtests and items by race and ethnicity given gold-standard clinical diagnosis of cognitive status. We analyzed data from the National Alzheimer Coordinating Center Uniform Data Set March 2018 data freeze. Stepwise regression was used to determine which subtests predicted cognitive status (normal cognition, MCI, or dementia), by race/ethnicity. Item discrimination and difficulty was calculated by race/ethnicity and cognitive status. In our sample (n=3895), with an average age of 69.7, 80.7% were non-Hispanic white, 15.0% were non-Hispanic black, and 4.2% were Hispanic. Among non-Hispanic whites all subtests, education, and age predicted clinician diagnosis, while visuospatial/executive, attention, language, delayed recall, and orientation subtests were predictive among non-Hispanic blacks and visuospatial/executive, delayed recall, and orientation subtests and education were predictive among Hispanics. Item discrimination and difficulty varied by race/ethnicity and cognitive status. By understanding the psychometric properties of MoCA subtests, we can focus on subtests that have higher discrimination and more diagnostic utility. Subtests should be further evaluated for use in screening of minority individuals.

Internal consistency and concurrent validity of the Montreal Cognitive Assessment in individuals with major depressive disorder

This study aimed to determine the internal consistency and concurrent validity of the Montreal Cognitive Assessment (MoCA), as well as its subtests, in patients with major depressive disorder (MDD). Participants were patients with DSM-IV MDD aged between 21 and 65 years. Neurocognitive function was assessed by using the MoCA and 12 neurocognitive tests. The composite z-score of 12 neurocognitive tests, which indicated the global cognitive performance, was calculated. Participants were 57 outpatients with MDD. Except the MoCA Orientation, each of the MoCA subtests showed a wide range of scores. The average inter-item correlation and the Cronbach's alpha of MoCA were 0.24 and 0.64, respectively. The MoCA total score was significantly and highly associated with the composite z-score of 12 neurocognitive tests (Pearson's r=0.78, p<0.001). The score of each MoCA subtest was significantly and moderately correlated with the z-score of its analogous neuropsychological test (absolute Spearman's rs's=0.33−0.56, p's≤0.01). The MoCA and its subtests are reliable and valid for assessing global and specific cognitive performance in patients with MDD and could be a tool for screening neurocognitive deficits in depressed patients.

Cognitive Function Characteristics of Parkinson's Disease with Sleep Disorders.

Objective. The aim of this study was to investigate the cognitive function characteristics of Parkinson's disease (PD) with sleep disorders. Methods. Consecutive patients with PD (n = 96), patients with primary sleep disorders (n = 76), and healthy control subjects (n = 66) were assessed. The patients with PD were classified into sleep disorder (PD-SD) and non-sleep disorder (PD-NSD) groups. Results. Among 96 patients with PD, 69 were diagnosed with a sleep disorder. There were 38 sleep disorder cases, 31 RBD cases, and 27 NSD cases. On the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and MoCA subtests, patients in the PD-SD, primary sleep disorder, and PD-NSD groups exhibited lower scores than those in the control group. Moreover, the PD-SD patients exhibited more significant cognitive impairment than was observed in the primary sleep disorder patients. In the PD-SD subgroup, the attention scores on the MoCA and on MoCA subtests were lower in the PD with RBD group than in the PD with insomnia group. Conclusion. PD with sleep disorders may exacerbate cognitive dysfunction in patients. PD associated with different types of sleep disorders differentially affects cognitive functions, and patients with PD with RBD exhibited poorer cognitive function than was seen in patients with PD with insomnia.

Some aspects of the validity of the Montreal Cognitive Assessment (MoCA) for evaluating cognitive impairment in Brazilian patients with Parkinson's disease.

BackgroundThe Montreal Cognitive Assessment (MoCA) is a short global cognitive scale, and some studies suggest it is useful for evaluating cognition in patients with Parkinson's disease (PD). However, its accuracy has been questioned in studies involving patients with low education.ObjectiveWe sought to assess whether some of the MoCA subtests contribute to the low accuracy of the test.MethodsWe performed a cross-sectional retrospective analysis of clinical data in a cohort of 71 patients with PD, most with less than 8 years of education. Patients were examined using the MDS-UPDRS, Hoehn and Yahr and the MoCA. The data were analyzed using mainly descriptive statistics.ResultsWe analyzed the data of 66 patients that were not demented according to the clinical evaluation and classified them using the proposed cut-off MoCA scores for diagnosis of MCI and dementia. Thirteen patients (19.7%) were classified as having normal cognition, 24 (36.3%) MCI and 29 (43.9%) dementia. Patients with dementia had longer disease duration (p=0.016) and lower education (p=0.0001). Total MoCA scores had a an almost normal distribution with a wide range of scores and only one maximum score. Performance on the MoCA was highly correlated with education (correlation coefficient=0.66, p=0.0001). At least five of the 10 MoCA subtests showed significant floor effects.ConclusionWe believe that some of the MoCA subtests may be too difficult to be completed by PD patients with low educational level, thus contributing to the test's poor diagnostic accuracy.

P.2.b.010 - Internal consistency and concurrent validity of the Montreal Cognitive Assessment in individuals with major depressive disorder

This study aimed to determine the internal consistency and concurrent validity of the Montreal Cognitive Assessment (MoCA), as well as its subtests, in patients with major depressive disorder (MDD). Participants were patients with DSM-IV MDD aged between 21 and 65 years. Neurocognitive function was assessed by using the MoCA and 12 neurocognitive tests. The composite z-score of 12 neurocognitive tests, which indicated the global cognitive performance, was calculated. Participants were 57 outpatients with MDD. Except the MoCA Orientation, each of the MoCA subtests showed a wide range of scores. The average inter-item correlation and the Cronbach's alpha of MoCA were 0.24 and 0.64, respectively. The MoCA total score was significantly and highly associated with the composite z-score of 12 neurocognitive tests (Pearson's r=0.78, p<0.001). The score of each MoCA subtest was significantly and moderately correlated with the z-score of its analogous neuropsychological test (absolute Spearman's rs's=0.33-0.56, p's≤0.01). The MoCA and its subtests are reliable and valid for assessing global and specific cognitive performance in patients with MDD and could be a tool for screening neurocognitive deficits in depressed patients.

Screening for Cognitive Impairment in Parkinson's Disease: Improving the Diagnostic Utility of the MoCA through Subtest Weighting.

BackgroundGiven the high prevalence of cognitive impairment in Parkinson’s disease (PD), cognitive screening is important in clinical practice. The Montreal Cognitive Assessment (MoCA) is a frequently used screening test in PD to detect mild cognitive impairment (PD-MCI) and Parkinson’s disease dementia (PD-D). However, the proportion in which the subtests are represented in the MoCA total score does not seem reasonable. We present the development and preliminary evaluation of an empirically based alternative scoring system of the MoCA which aims at increasing the overall diagnostic accuracy.MethodsIn study 1, the MoCA was administered to 40 patients with PD without cognitive impairment (PD-N), PD-MCI, or PD-D, as defined by a comprehensive neuropsychological test battery. The new MoCA scoring algorithm was developed by defining Areas under the Curve (AUC) for MoCA subtests in a Receiver Operating Characteristic (ROC) and by weighting the subtests according to their sensitivities and specificities. In study 2, an independent sample of 24 PD patients (PD-N, PD-MCI, or PD-D) was tested with the MoCA. In both studies, diagnostic accuracy of the original and the new scoring procedure was calculated.ResultsDiagnostic accuracy increased with the new MoCA scoring algorithm. In study 1, the sensitivity to detect cognitive impairment increased from 62.5% to 92%, while specificity decreased only slightly from 77.7% to 73%; in study 2, sensitivity increased from 68.8% to 81.3%, while specificity stayed stable at 75%.ConclusionThis pilot study demonstrates that the sensitivity of the MoCA can be enhanced substantially by an empirically based weighting procedure and that the proposed scoring algorithm may serve the MoCA’s actual purpose as a screening tool in the detection of cognitive dysfunction in PD patients better than the original scoring of the MoCA. Further research with larger sample sizes is necessary to establish efficacy of the alternate scoring system.