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Published on: January 11, 2020
The MMSE and MoCA for Screening Cognitive Impairment in Less Educated Patients with Parkinson's Disease
Ji In Kim1, Mun Kyung Sunwoo2, Young H Sohn3
1Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Objective:
To explore whether the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) can be used to screen for dementia or mild cognitive impairment (MCI) in less educated patients with Parkinson's disease (PD).
Methods:
We reviewed the medical records of PD patients who had taken the Korean MMSE (K-MMSE), Korean MoCA (K-MoCA), and comprehensive neuropsychological tests. Predictive values of the K-MMSE and K-MoCA for dementia or MCI were analyzed in groups divided by educational level.
Results:
The discriminative powers of the K-MMSE and K-MoCA were excellent [area under the curve (AUC) 0.86-0.97] for detecting dementia but not for detecting MCI (AUC 0.64-0.85). The optimal screening cutoff values of both tests increased with educational level for dementia (K-MMSE < 15 for illiterate, < 20 for 0.5-3 years of education, < 23 for 4-6 years, < 25 for 7-9 years, and < 26 for 10 years or more; K-MoCA < 7 for illiterate, < 13 for 0.5-3 years, < 16 for 4-6 years, < 19 for 7-9 years, < 20 for 10 years or more) and MCI (K-MMSE < 19 for illiterate, < 26 for 0.5-3 years, < 27 for 4-6 years, < 28 for 7-9 years, and < 29 for 10 years or more; K-MoCA < 13 for illiterate, < 21 for 0.5-3 years, < 23 for 4-6 years, < 25 for 7-9 years, < 26 for 10 years or more).
Conclusion:
Both MMSE and MoCA can be used to screen for dementia in patients with PD, regardless of educational level; however, neither test is sufficient to discriminate MCI from normal cognition without additional information.
Insights
The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) effectively screen for dementia in Parkinson's disease (PD) patients across all education levels. However, these tools alone are insufficient for diagnosing mild cognitive impairment (MCI) in PD patients.
Area of Science:
- Neurology
- Cognitive Science
- Geriatrics
Background:
- Parkinson's disease (PD) is a neurodegenerative disorder often associated with cognitive impairment, including dementia and mild cognitive impairment (MCI).
- Accurate and accessible screening tools are crucial for early detection and management of cognitive decline in PD patients.
- Educational level can influence performance on cognitive assessments, posing challenges for screening in diverse patient populations.
Purpose of the Study:
- To evaluate the efficacy of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in screening for dementia and MCI among Parkinson's disease (PD) patients with varying educational backgrounds.
- To determine if adjusted cutoff scores are necessary for different educational strata when using MMSE and MoCA for PD-related cognitive assessment.
Main Methods:
- Retrospective analysis of medical records from PD patients who underwent Korean versions of MMSE (K-MMSE), MoCA (K-MoCA), and comprehensive neuropsychological testing.
- Statistical analysis of the predictive values and discriminative powers (Area Under the Curve - AUC) of K-MMSE and K-MoCA for dementia and MCI.
- Stratification of patients by educational level to analyze the impact of education on test performance and optimal cutoff scores.
Main Results:
- Both K-MMSE and K-MoCA demonstrated excellent discriminative power for detecting dementia in PD patients (AUC 0.86-0.97), irrespective of educational level.
- The tests showed lower, but still significant, discriminative power for detecting MCI (AUC 0.64-0.85).
- Optimal screening cutoff scores for both dementia and MCI increased with higher educational attainment, indicating a need for education-adjusted thresholds.
Conclusions:
- The MMSE and MoCA are valuable screening tools for dementia in Parkinson's disease patients, applicable across a wide range of educational backgrounds.
- These cognitive screening tools, by themselves, are not sufficient to reliably differentiate mild cognitive impairment (MCI) from normal cognition in PD patients.
- Further diagnostic evaluation is recommended for suspected MCI in PD patients, even with normal scores on MMSE or MoCA, especially considering educational influences.
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