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The Montreal Cognitive Assessment: a screening tool for mild cognitive impairment in REM sleep behavior disorder
Jean-François Gagnon1, Ronald B Postuma, Steve Joncas
1Centre d'étude du sommeil et des rythmes biologiques, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada. jean-francois.gagnon.5@umontreal.ca
Abstract:
Mild cognitive impairment (MCI) is a frequent feature in idiopathic REM sleep behavior disorder (RBD), a sleep disturbance that can be a preclinical stage of Parkinson's disease or Lewy body dementia. We evaluated the sensitivity and specificity of two brief screening tools, the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE), in detecting MCI in idiopathic RBD. Thirty-eight idiopathic RBD patients underwent a comprehensive neuropsychological assessment, including the MoCA and the MMSE. Receiver operating characteristic curves were created for the MoCA and the MMSE to assess their ability to identify MCI in idiopathic RBD patients, with neuropsychological assessment as the gold standard. For the MoCA, a normality cutoff of 26 yielded the best balance between sensitivity (76%) and specificity (85%) with a correct classification of 79%. For the MMSE, the optimal normality cutoff was 30, with a sensitivity of 84% and a specificity of 54% and a correct classification of 74%. The MoCA is superior to the MMSE in detecting MCI in idiopathic RBD patients, showing good sensitivity and very good specificity.
Insights
The Montreal Cognitive Assessment (MoCA) effectively screens for mild cognitive impairment (MCI) in idiopathic REM sleep behavior disorder (RBD) patients, outperforming the Mini-Mental State Examination (MMSE) in accuracy.
Area of Science:
- Neurology
- Sleep Medicine
- Cognitive Science
Background:
- Idiopathic REM sleep behavior disorder (RBD) is frequently associated with mild cognitive impairment (MCI).
- MCI in idiopathic RBD may indicate a preclinical stage of neurodegenerative diseases like Parkinson's disease or Lewy body dementia.
- Brief screening tools are needed to identify MCI in this population.
Purpose of the Study:
- To compare the sensitivity and specificity of the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) for detecting MCI in patients with idiopathic RBD.
- To determine which screening tool is more effective for identifying cognitive deficits in idiopathic RBD.
Main Methods:
- Thirty-eight patients with idiopathic RBD underwent a comprehensive neuropsychological assessment.
- The MoCA and MMSE were administered to all participants.
- Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of MoCA and MMSE against the gold standard neuropsychological assessment.
Main Results:
- The MoCA, with a cutoff of 26, demonstrated 76% sensitivity and 85% specificity, achieving 79% correct classification.
- The MMSE, with a cutoff of 30, showed 84% sensitivity and 54% specificity, with 74% correct classification.
- The MoCA exhibited superior performance compared to the MMSE in identifying MCI in idiopathic RBD patients.
Conclusions:
- The MoCA is a more effective screening tool than the MMSE for detecting mild cognitive impairment in individuals with idiopathic REM sleep behavior disorder.
- The MoCA offers a good balance of sensitivity and very good specificity for identifying MCI in this at-risk group.
