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Published on: September 20, 2018
Clinical Manifestations
Youssef A Ismail1, Huda A Auf1, Shahd A Sadik1
1Faculty of Medicine Port Said Univeristy, Egypt, Port Said, Port Said, Egypt.
Background:
Dementia has been classified as major neurocognitive disorder and it typically presented with substantial impairment in at least one cognitive domain, interfering with day-to-day activities and if the impairment was moderate and yet to interfere severely with activities, it would be diagnosed as mild neurocognitive disorder. This study aims to evaluate the sensitivity and specificity of MoCA to determine its suitability as a screening tool in screening programs.
Methods:
The study analyzed data from participants aged 55 and older, recruited from U.S. Alzheimer's Disease Research Centers (ADRCs), using a National Alzheimer Coordinating Center Uniformed Data Set (NACC-UDS). Participants were classified based on patient records into demented and non-demented groups, with the non-demented group further categorized into those with normal cognition and cognitive impairment (CI).
Results:
The study utilized an initial dataset of 188,700 participant records from NACC. After applying inclusion criteria, 16,309 participants were included. The participants had complete diagnostic information, clinician-conducted cognitive assessments, and MoCA scores. The participants were categorized into three groups: 7,624 with no cognitive impairment (NoCI), 4,893 with MCI, and 3,792 with dementia. The optimum cutoff scores against NoCI as calculated by the Youden index were less than 24 for detecting MCI, sensitivity 77 % (95% CI, 76-78), specificity 69 % (95%CI, 67-69), cutoff scores against MCI as calculated by the Youden index were less than 19 for detecting dementia, sensitivity 72% (95% CI, 70-73), specificity 80 % (95% CI, 79-81), and cutoff scores against NoCI as calculated by the Youden index were less than 21 for detecting dementia, sensitivity 83% (95% CI, 82-85), specificity 82 % (95% CI, 81-83). Although PPV was generally low, the high NPV across comparisons underscores the MoCA's effectiveness in ruling out cognitive impairment.
Conclusion:
The study confirms MoCA as an effective tool for detecting dementia, showing 83% sensitivity and 82% specificity at a cutoff value of 21. With a high NPV of 94%, MoCA is particularly reliable for ruling out dementia. Its ability to identify MCI is moderate, with a sensitivity of 77.3% at cutoff of 24.
Insights
The Montreal Cognitive Assessment (MoCA) effectively screens for dementia, demonstrating high sensitivity and specificity. It is particularly useful for ruling out dementia, with a high negative predictive value (NPV).
Area of Science:
- Neuroscience
- Gerontology
- Psychometrics
Background:
- Dementia, classified as major neurocognitive disorder, involves significant cognitive impairment affecting daily life.
- Mild neurocognitive disorder (MND) is diagnosed when cognitive impairment is moderate and does not yet severely impact daily activities.
- The Montreal Cognitive Assessment (MoCA) is evaluated for its sensitivity and specificity as a screening tool for neurocognitive disorders.
Purpose of the Study:
- To assess the diagnostic accuracy of the MoCA for identifying dementia and mild cognitive impairment (MCI).
- To determine the suitability of MoCA as a screening tool in large-scale programs.
- To establish optimal cutoff scores for MoCA in differentiating cognitive states.
Main Methods:
- Analysis of data from 16,309 participants aged 55+ recruited from U.S. Alzheimer's Disease Research Centers (ADRCs).
- Participants were categorized into three groups: no cognitive impairment (NoCI), mild cognitive impairment (MCI), and dementia, based on patient records and clinician-conducted cognitive assessments.
- The National Alzheimer Coordinating Center Uniformed Data Set (NACC-UDS) was utilized, including complete diagnostic information and MoCA scores.
Main Results:
- The MoCA demonstrated high accuracy in detecting dementia against NoCI, with a sensitivity of 83% and specificity of 82% at a cutoff score of 21.
- For detecting MCI against NoCI, the MoCA showed a sensitivity of 77% and specificity of 69% at a cutoff score of 24.
- The MoCA exhibited a high negative predictive value (NPV) across comparisons, indicating its strength in ruling out cognitive impairment, particularly dementia (NPV of 94%).
Conclusions:
- The MoCA is confirmed as an effective screening tool for dementia, with strong sensitivity and specificity.
- The MoCA's high NPV makes it a reliable instrument for excluding dementia in clinical settings.
- The MoCA shows moderate ability in identifying MCI, suggesting its utility for broader cognitive screening.
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