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Title: Montreal Cognitive Assessment More Sensitive to Cognitive Deficits Than Mini-Mental Status Examination for Parkinson's Disease: Presented at ANA
URL: http://www.pslgroup.com/dg/22D74A.htm
Doctor's Guide
September 24, 2008

By Andrew N. Wilner, MD

SALT LAKE CITY, Utah -- September 24, 2008 -- The Montreal Cognitive Assessment (MoCA) is more sensitive to subtle cognitive deficits in patients with Parkinson's disease compared with the conventional Mini-Mental Status Examination (MMSE), according to a comparative study presented here at the American Neurological Association (ANA) 133rd Annual Meeting.

The MMSE is the most commonly used screening instrument to detect cognitive dysfunction in Parkinson's disease, according to lead author Stephanie Lessig, MD, University of California, San Diego Medical Center, San Diego, California.

While it has the advantage of brevity, taking only 7 to 8 minutes to administer, the sensitivity of the MMSE to early cognitive impairment has been questioned. More complete neuropsychological testing requires several hours.

The MoCA, a relatively new cognitive screening test takes 10 to 12 minutes to administer. Both tests are scored from 0 to 30, with lower scores representing cognitive dysfunction.

In their study, Dr. Lessig and colleagues administered the MMSE and the MoCA to 61 patients with Parkinson's disease and 68 age-matched controls. All patients had approximately 15 years of education.

Parkinson's patients were divided into those who scored >=28 or greater on the MMSE (n = 39, mean age 69.1) and those who scored <28 (n = 22, mean age 72.2).

Results show that patients with Parkinson's disease scored lower on the MoCA and had a greater range in their scores compared with their results on the MMSE. For example, Parkinson's patients who scored <28 on the MMSE lost 20% of possible points for memory. However, on the MoCA, the same group lost more than 60% of possible points for memory.

The MoCA was also more sensitive than the MMSE in detecting cognitive impairment in the group with MMSE scores >=28. This group lost less than 20% of points for memory on the MMSE, but more than 50% of points for memory on the MoCA. In addition, patients with MMSE scores showing normal cognitive function did not always have MoCA scores showing normal cognitive function.

One explanation for the MoCA's greater sensitivity for cognitive dysfunction in Parkinson's disease is its specific executive function tests -- "Trails," "Fluency," "Abstraction," "Target," and "Digit Span." The MMSE does not contain similar tests.

"We now use the MoCA in our research and clinic because it is more sensitive than the MMSE to early cognitive deficits in Parkinson's disease," Dr. Lessig concluded.


[Presentation title: Examination of the Montreal Cognitive Assessment (MoCA) and MMSE in Parkinson's disease (PD). Abstract T-82]

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