OpenLB
Open Library of Bioscience
Advanced Search
International journal of geriatric psychiatry
10, 2019;34 (10): 1515-1525.

Accuracy of the short-form Montreal Cognitive Assessment: Systematic review and validation.

Jennifer A McDicken, Emma Elliott, Gareth Blayney, Stephen Makin, Myzoon Ali, Andrew J Larner, Terence J Quinn, VISTA-Cognition Collaborators
Author Information
  1. Jennifer A McDicken: Department Medicine for the Elderly, Queen Elizabeth University Hospital, Glasgow, UK.
  2. Emma Elliott: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. ORCID
  3. Gareth Blayney: Department Medicine for the Elderly, Queen Elizabeth University Hospital, Glasgow, UK.
  4. Stephen Makin: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
  5. Myzoon Ali: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
  6. Andrew J Larner: Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
  7. Terence J Quinn: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. ORCID
PMID: 31243810 DOI: 10.1002/gps.5162

Abstract

INTRODUCTION: Short-form versions of the Montreal Cognitive Assessment (SF-MoCA) are increasingly used to screen for dementia in research and practice. We sought to collate evidence on the accuracy of SF-MoCAs and to externally validate these assessment tools.
METHODS: We performed systematic literature searching across multidisciplinary electronic literature databases, collating information on the content and accuracy of all published SF-MoCAs. We then validated all the SF-MoCAs against clinical diagnosis using independent stroke (n = 787) and memory clinic (n = 410) data sets.
RESULTS: We identified 13 different SF-MoCAs (21 studies, n = 6477 participants) with differing test content and properties. There was a pattern of high sensitivity across the range of SF-MoCA tests. In the published literature, for detection of post stroke cognitive impairment, median sensitivity across included studies: 0.88 (range: 0.70-1.00); specificity: 0.70 (0.39-0.92). In our independent validation using stroke data, median sensitivity: 0.99 (0.80-1.00); specificity: 0.40 (0.14-0.87). To detect dementia in older adults, median sensitivity: 0.88 (0.62-0.98); median specificity: 0.87 (0.07-0.98) in the literature and median sensitivity: 0.96 (range: 0.72-1.00); median specificity: 0.36 (0.14-0.86) in our validation. Horton's SF-MoCA (delayed recall, serial subtraction, and orientation) had the most favorable properties in stroke (sensitivity: 0.90, specificity: 0.87, positive predictive value [PPV]: 0.55, and negative predictive value [NPV]: 0.93), whereas Cecato's "MoCA reduced" (clock draw, animal naming, delayed recall, and orientation) performed better in the memory clinic (sensitivity: 0.72, specificity: 0.86, PPV: 0.55, and NPV: 0.93).
CONCLUSIONS: There are many published SF-MoCAs. Clinicians and researchers using a SF-MoCA should be explicit about the content. For all SF-MoCA, sensitivity is high and similar to the full scale suggesting potential utility as an initial cognitive screening tool. However, choice of SF-MoCA should be informed by the clinical population to be studied.

Keywords

Montreal Cognitive Assessment cognitive impairment dementia sensitivity specificity

References

Harrison JK, Noel-Storr AH, Demeyere N, Reynish EL, Quinn TJ. Outcomes measures in a decade of dementia and mild cognitive impairment trials. Alzheimer's Res Therapy. 2016;8(1):48.
Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699.
Davis DH, Creavin ST, Yip JL, Noel-Storr AH, Brayne C, Cullum S. Montreal cognitive assessment for the diagnosis of Alzheimer's disease and other dementias. Cochrane Database Syst Rev. 2015;(10):CD010775.
Julayanont P, Phillips N, Chertkow H, Nasreddine ZS. Montreal Cognitive Assessment (MoCA): concept and clinical review. In: Larner AJ, ed. Cognitive Screening Instruments: A Practical Approach. London: Springer London; 2013:111-151.
Lees RA, Hendry Ba K, Broomfield N, Stott D, Larner AJ, Quinn TJ. Cognitive assessment in stroke: feasibility and test properties using differing approaches to scoring of incomplete items. Int J Geriatr Psychiatry. 2017;32(10):1072-1078.
Jenkinson C, Fitzpatrick R, Crocker H, Peters M. The stroke impact scale: validation in a UK setting and development of a SIS short form and SIS index. Stroke. 2013;44(9):2532-2535.
MacIsaac RL, Ali M, Taylor-Rowan M, et al. Use of a 3-item short-form version of the Barthel Index for use in stroke: systematic review and external validation. Stroke. 2017;48(3):618-623.
Davis DHJ, Creavin ST, Noel-Storr A, et al. Neuropsychological tests for the diagnosis of Alzheimer's disease dementia and other dementias: a generic protocol for cross-sectional and delayed-verification studies. Cochrane Database Syst Rev. 2013(3):Art No: CD010460.
McInnes MDF, Moher D, Thombs BD, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA. 2018;319(4):388-396.
Julayanont P, Tangwongchai S, Hemrungrojn S, et al. The Montreal Cognitive Assessment-Basic: a screening tool for mild cognitive impairment in illiterate and low-educated elderly adults. J Am Geriatr Soc. 2015;63(12):2550-2554.
Takwoingi Y, Quinn TJ. Review of diagnostic test accuracy (DTA) studies in older people. Age Ageing. 2018;47(3):349-355.
Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529-536.
Noel-Storr AH, McCleery JM, Richard E, et al. Reporting standards for studies of diagnostic test accuracy in dementia: the STARDdem initiative. Neurol. 2014;83(4):364-373.
Lees R, Selvarajah J, Fenton C, et al. Test accuracy of cognitive screening tests for diagnosis of dementia and multidomain cognitive impairment in stroke. Stroke. 2014;45(10):3008-3018.
Ali M, Bath P, Brady M, et al. Development, expansion, and use of a stroke clinical trials resource for novel exploratory analyses. Int J Stroke: Official Journal of the International Stroke Society. 2012;7(2):133-138.
Larner AJ. Screening utility of the Montreal cognitive assessment (MoCA): in place of-or as well as-the MMSE? Int Psychogeriatr. 2012;24(3):391-396.
Larner AJ. Short Montreal Cognitive Assessment: validation and reproducibility. J Geriatr Psychiatry Neurol. 2017;30(2):104-108.
Campbell N, Rice D, Friedman L, Speechley M, Teasell RW. Screening and facilitating further assessment for cognitive impairment after stroke: application of a shortened Montreal Cognitive Assessment (miniMoCA). Disabil Rehabil. 2016;38(6):601-604.
Horton DK, Hynan LS, Lacritz LH, Rossetti HC, Weiner MF, Cullum CM. An abbreviated Montreal Cognitive Assessment (MoCA) for dementia screening. Clin Neuropsychol. 2015;29(4):413-425.
Bocti C, Legault V, Leblanc N, et al. Vascular cognitive impairment: most useful subtests of the Montreal Cognitive Assessment in minor stroke and transient ischemic attack. Dement Geriatr Cogn Disord. 2013;36(3-4):154-162.
Lin HF, Chern CM, Chen HM, et al. Validation of NINDS-VCI neuropsychology protocols for vascular cognitive impairment in Taiwan. PLoS ONE. 2016;11(6):e0156404.
Mai LM, Oczkowski W, Mackenzie G, et al. Screening for cognitive impairment in a stroke prevention clinic using the MoCA. Canadian J Neurologic Sci Le Journal Canadien Des Sciences Neurologiques. 2013;40(2):192-197.
Pendlebury ST, Welch SJ, Cuthbertson FC, Mariz J, Mehta Z, Rothwell PM. Telephone assessment of cognition after transient ischemic attack and stroke: modified telephone interview of cognitive status and telephone Montreal cognitive assessment versus face-to-face Montreal Cognitive Assessment and neuropsychological battery. Stroke. 2013;44(1):227-229.
Wong A, Nyenhuis D, Black SE, et al. Montreal Cognitive Assessment 5-minute protocol is a brief, valid, reliable, and feasible cognitive screen for telephone administration. Stroke. 2015;46(4):1059-1064.
Cecato JF, Martinelli JE, Izbicki R, Yassuda MS, Aprahamian I. A subtest analysis of the Montreal cognitive assessment (MoCA): which subtests can best discriminate between healthy controls, mild cognitive impairment and Alzheimer's disease? Int Psychogeriatr. 2016;28(5):825-832.
Xu X, Chan QL, Hilal S, et al. The diagnostic utility of the NINDS-CSN neuropsychological battery in memory clinics. Dementia Geriatric Cog Disorders Extra. 2016;6(2):276-282.
Roalf DR, Moore TM, Wolk DA, et al. Defining and validating a short form Montreal Cognitive Assessment (s-MoCA) for use in neurodegenerative disease. J Neurol Neurosurg Psychiatry. 2016;87(12):1303-1310.
Wittich W, Phillips N, Nasreddine SZ, Chertkow H. Sensitivity and specificity of the Montreal Cognitive Assessment modified for individuals who are visually impaired. J Visual Impairment Blindness. 2010;104(6):360-368.
Kaur D, Kumar G, Singh AK. Quick screening of cognitive function in Indian multiple sclerosis patients using Montreal cognitive assessment test-short version. Ann Indian Acad Neurol. 2013;16(4):585-589.
Cameron JD, Gallagher R, Pressler SJ, et al. Sensitivity and specificity of a five-minute cognitive screening test in patients with heart failure. J Card Fail. 2016;22(2):99-107.
Lim JS, Oh MS, Lee JH, et al. Prediction of post-stroke dementia using NINDS-CSN 5-minute neuropsychology protocol in acute stroke. Int Psychogeriatr. 2017;29(5):777-784.
Freitas S, Batista S, Afonso AC, Simoes MR. The Montreal Cognitive Assessment (MoCA) as a screening test for cognitive dysfunction in multiple sclerosis. Appl Neuropsychol Adult. 2018;25(1):57-70.
Dong Y, Koay WI, Yeo LL, et al. Rapid screening for cognitive impairment in Parkinson's disease: a pilot study. Parkinson's Dis. 2015;2015:348063.
Panenková E, Kopecek M, Lukavsky J. Item analysis and possibility to abbreviate the Montreal cognitive assessment. Ceska Slov Psychiatr. 2016;112:63-69.
Bocti C, Cossette P, Fulop T, Lacombe G, Létourneau C. Designing an abridged Montreal Cognitive Assessment for more efficient cognitive screening. Alzheimers Dement. 2012;8(4):P539.
Dong C, Xu K, Chen C. An ultra-short cognitive screening test to detect significant post-stroke vascular cognitive impairment. Circulation. 2015;132(suppl_3):A18752-A18752.
Davies LM, Oczkowski W, MacKenzie G, Sahlas DJ. Detection of cognitive impairment in a stroke prevention clinic using the moca: rationale for prospective validation of a mini-MoCA. 2nd Canadian Stroke Congress; 2011; Canada.
Goetz C, Coste J, Lemetayer F, et al. Item reduction based on rigorous methodological guidelines is necessary to maintain validity when shortening composite measurement scales. J Clin Epidemiol. 2013;66(7):710-718.

Grants

  1. /Chief Scientist Office

MeSH Term

Cognition
Cognitive Dysfunction
Dementia
Humans
Memory
Mental Status and Dementia Tests
Sensitivity and Specificity
Stroke
Journal Article Research Support, Non-U.S. Gov't Systematic Review Validation Study

Word Cloud

Similar Articles

Cited By