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Evaluating the Duke Iterative Cognitive Examination Against the Montreal Cognitive Assessment: Validity and Clinical
Christine Park1, Thomas J Farrer2, Jill Z Stuart3
1Department of Neurology, Duke University School of Medicine, Durham, NC.
Neurology. Clinical Practice
|May 11, 2026
Summary
The Duke Iterative Cognitive Examination (DICE) shows strong concurrent validity with the MoCA, serving as a reliable tool for assessing cognitive function in older adults and distinguishing between healthy individuals, mild cognitive impairment, and dementia.
Area of Science:
- Neurology
- Gerontology
- Psychometrics
Background:
- Cognitive screening tools are crucial for diagnosing mild cognitive impairment (MCI) and dementia.
- Existing tools may have reduced sensitivity over time, necessitating evaluation of new instruments.
- The Duke Iterative Cognitive Examination (DICE) is a novel screening tool for cognitive assessment.
Purpose of the Study:
- To establish the concurrent validity of the DICE against the Montreal Cognitive Assessment (MoCA).
- To evaluate the clinical utility of the DICE in differentiating between healthy older adults, individuals with MCI, and those with dementia.
Main Methods:
- A prospective study enrolled 126 healthy older adults, 59 with MCI, and 66 with dementia (age 55+).
- Participants completed both the MoCA and the DICE in a counterbalanced order.
- Statistical analyses included Spearman correlation, likelihood ratio chi-square tests, and receiver operating characteristic (ROC) curve analyses.
Main Results:
- A strong correlation (ρ = 0.89, p < 0.001) was found between the DICE and MoCA scores, indicating concurrent validity.
- Both the MoCA and DICE demonstrated significant predictive value for diagnostic groups.
- ROC analyses showed strong classification accuracy for both measures across control, MCI, and dementia groups.
Conclusions:
- The DICE performs comparably to the MoCA in distinguishing between healthy older adults, MCI, and dementia groups.
- The DICE is a valid and reasonable cognitive screening measure.
- Future research should explore the DICE's test-retest reliability and longitudinal predictive capabilities.
