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A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
The Optimal Short Version of Montreal Cognitive Assessment in Diagnosing Mild Cognitive Impairment and Dementia
1Department of Geriatric Psychiatry, Institute of Mental Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Objectives:
While various short variants of the Montreal Cognitive Assessment (MoCA) have been developed, they have not been compared among each other to determine the most optimal variant for routine use. This study evaluated the comparative performance of the short variants in identifying mild cognitive impairment or dementia (MCI/dementia).
Design:
Baseline data of a cohort study.
Setting:
Alzheimer's Disease Centers across the United States.
Participants:
Participants aged ≥50 years (n = 4606), with median age 70 (interquartile range 65-76).
Measures:
Participants completed MoCA and were evaluated for MCI/dementia. The various short variants of MoCA were compared in their performance in discriminating MCI/dementia, using areas under the receiver operating characteristic curve (AUCs).
Results:
All 7 short variants of MoCA had acceptable performance in discriminating MCI/dementia from normal cognition (AUC 87.7%-91.0%). However, only 2 variants by Roalf et al (2016) and Wong et al (2015) demonstrated comparable performance (AUC 88.4-88.9%) to the original MoCA (AUC 89.3%). Among the participants with higher education, only the variant by Roalf et al had similar AUC to the original MoCA. At the optimal cut-off score of <25, the original MoCA demonstrated 84.4% sensitivity and 76.4% specificity. In contrast, the short variant by Roalf et al had 87.2% sensitivity and 72.1% specificity at its optimal cut-off score of <13.
Conclusions/Implications:
The various short variants may not share similar diagnostic performance, with many limited by ceiling effects among participants with higher education. Only the short variant by Roalf et al was comparable to the original MoCA in identifying MCI or dementia even across education subgroups. This variant is one-third the length of the original MoCA and can be completed in <5 minutes. It provides a viable alternative when it is not feasible to administer the original MoCA in clinical practice and can be especially useful in nonspecialty clinics with large volumes of patients at high risk of cognitive impairment (such as those in primary care, geriatric, and stroke prevention clinics).
Insights
The Roalf et al. short variant of the Montreal Cognitive Assessment (MoCA) effectively identifies mild cognitive impairment or dementia (MCI/dementia), performing comparably to the original MoCA. This rapid screening tool is suitable for busy clinics and high-risk patients.
Area of Science:
- Neuroscience
- Gerontology
- Cognitive Psychology
Background:
- The Montreal Cognitive Assessment (MoCA) is widely used for detecting mild cognitive impairment (MCI) or dementia.
- Several short variants of the MoCA have been developed to improve efficiency in clinical settings.
- Comparative studies are needed to identify the optimal short MoCA variant for routine use.
Purpose of the Study:
- To compare the diagnostic performance of various short MoCA variants in identifying MCI/dementia.
- To determine if any short MoCA variant is comparable to the original MoCA, especially in individuals with higher education.
Main Methods:
- Analysis of baseline data from a cohort study involving 4606 participants aged 50 years and older.
- Evaluation of seven short MoCA variants against the original MoCA using receiver operating characteristic curves (AUCs) to assess discrimination of MCI/dementia.
- Assessment of performance across different education subgroups.
Main Results:
- All seven short MoCA variants showed acceptable performance (AUCs 87.7%-91.0%) in discriminating MCI/dementia.
- The Roalf et al. (2016) and Wong et al. (2015) variants demonstrated performance comparable to the original MoCA (AUC 89.3%).
- The Roalf et al. variant maintained similar performance to the original MoCA across education levels, unlike others which showed ceiling effects.
Conclusions:
- The Roalf et al. short MoCA variant is a viable alternative to the original MoCA for identifying MCI/dementia, particularly in primary care and geriatric settings.
- This 5-minute variant offers comparable diagnostic accuracy, even in highly educated individuals, addressing limitations of other short forms.
- Its efficiency makes it suitable for high-volume clinics managing patients at risk for cognitive impairment.
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