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Montreal Cognitive Assessment (MoCA): Validation Study for Vascular Dementia

Published online by Cambridge University Press:  08 June 2012

Sandra Freitas ,
Mário R. Simões ,
Lara Alves ,
Margarida Vicente  and
Isabel Santana
Sandra Freitas*
Affiliation:
Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental (CINEICC), Coimbra, Portugal
Mário R. Simões
Affiliation:
Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental (CINEICC), Coimbra, Portugal
Lara Alves
Affiliation:
Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
Margarida Vicente
Affiliation:
Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
Isabel Santana
Affiliation:
Neurology Department of the Coimbra University Hospital & Faculty of Medicine, University of Coimbra, Coimbra, Portugal
*
Correspondence and reprint requests to: Sandra Freitas, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802 Coimbra, Portugal. E-mail: sandrafreitas0209@gmail.com
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Abstract

The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the MMSE. The aim of the present study was to validate the MoCA as well as its short version, which was proposed by the NINDS-CSN VCI Harmonization Standards for screening Vascular Dementia (VaD) patients. The results, based on a homogeneous sample of 34 VaD patients, indicate that the MoCA is a psychometrically valid and reliable instrument for cognitive screening in VaD patients, showing excellent discriminant validity. Both the full and short versions of the MoCA had excellent diagnostic accuracy in discriminating VaD patients, exhibiting an area under curve (AUC) higher than the MMSE [AUC(MoCA full version) = .950; 95% IC = .868–.988; AUC(MoCA short version) = .936; 95% IC = .849–.981; AUC(MMSE) = .860; 95% IC = .754–.932]. With a cutoff below 17 on the MoCA full version and 8 on the short version, the results for sensitivity, specificity, positive and negative predictive values, and classification accuracy were superior compared to the MMSE. In conclusion, both versions of the MoCA are valid, reliable, sensitive and accurate screening instruments for VaD patients. (JINS, 2012, 18, 1–10)

Keywords

Neuropsychological testValidation studiesGeriatric assessmentCognitionVascular DementiaAlzheimer disease
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 18 , Issue 6 , November 2012 , pp. 1031 - 1040
Copyright
Copyright © The International Neuropsychological Society 2012

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References

Aggarwal, A., Kean, E. (2010). Comparison of the Folstein Mini Mental State Examination (MMSE) to the Montreal Cognitive Assessment (MoCA) as a cognitive screening tool in an inpatient rehabilitation setting. Neuroscience & Medicine, 1, 39–42.CrossRefGoogle Scholar
Alves, L., Simões, M. R., Martins, C. (2009). Teste de Leitura de Palavras Irregulares (TeLPI) [Reading Word Irregular Test]. Coimbra, Portugal: Serviço de Avaliação Psicológica da Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra [Psychological Assessment Department, Faculty of Psychology and Educational Sciences, University of Coimbra].Google Scholar
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. – Text Revised). Washington, DC: American Psychiatric Association Press.Google Scholar
Braaten, A.J., Parsons, T.D., McCue, R., Sellers, A., Burns, W.J. (2006). Neurocognitive differential diagnosis of dementing diseases: Alzheimer's disease, vascular dementia, frontotemporal dementia, and major depressive disorder. International Journal of Neuroscience, 116, 1271–1293.CrossRefGoogle ScholarPubMed
Canadian Study of Health and Aging Working Group. (1994). Canadian study of health and aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150(6), 899–913.Google Scholar
Cumming, T.B., Bernhardt, J., Linden, T. (2011). The Montreal Cognitive Assessment: Short cognitive evaluation in a large stroke trial. Stroke, 42, 2642–2644. doi:10.1161/STROKEAHA.111.619486CrossRefGoogle Scholar
Desmond, D.W. (2004). Vascular dementia. Clinical Neuroscience Research, 3, 437–448.CrossRefGoogle Scholar
Dong, Y., Sharma, V.K., Chan, B.P., Venketasubramanian, N., Teoh, H.L., Seet, R.C., Chen, C. (2010). The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. Journal of the Neurological Sciences, 299(1-2), 15–18.CrossRefGoogle Scholar
Folstein, M., Folstein, S., McHugh, P. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198.CrossRefGoogle Scholar
Freitas, S., Santana, I., Simões, M.R. (2010). The sensitivity of the MoCA and MMSE to cognitive decline: A longitudinal study. Alzheimer's & Dementia, 6(4), S353–S354.CrossRefGoogle Scholar
Freitas, S., Simões, M.R., Alves, L., Duro, D., Santana, I. (2012). Montreal Cognitive Assessment (MoCA): Validation study for Frontotemporal Dementia. Journal of Geriatric Psychiatry and Neurology, in press.CrossRefGoogle Scholar
Freitas, S., Simões, M.R., Alves, L., Santana, I. (2011). Montreal Cognitive Assessment (MoCA): Normative study for the Portuguese population. Journal of Clinical and Experimental Neuropsychology, 33(9), 989–996.CrossRefGoogle ScholarPubMed
Freitas, S., Simões, M. R., Alves, L., Santana, I. (2012). Montreal Cognitive Assessment (MoCA): Validation study for Mild Cognitive Impairment and Alzheimer's disease. Alzheimer Disease and Associated Disorders, doi:10.1097/WAD.0b013e3182420bfeCrossRefGoogle Scholar
Freitas, S., Simões, M.R., Marôco, J., Alves, L., Santana, I. (2012). Construct validity of the Montreal Cognitive Assessment (MoCA). Journal of International Neuropsychology Society, 18, 1–9.Google ScholarPubMed
Garrett, K.D., Paul, R.H., Libon, D.J., Cohen, R.A. (2004). Defining the diagnosis of vascular dementia. Applied Neuropsychology, 11(4), 202–207.CrossRefGoogle ScholarPubMed
Gauthier, S., Patterson, C., Gordon, M., Soucy, J., Schubert, F., Leuzy, A. (2011). Commentary on “Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. ”: A Canadian perspective. Alzheimer's & Dementia,, 7, 330–332.CrossRefGoogle ScholarPubMed
Guerreiro, M. (1998). Contributo da Neuropsicologia para o estudo das demências [Contribution of Neuropsychology to the study of dementia] (Unpublished doctoral dissertation). University of Lisbon, Lisbon.Google Scholar
Hachinski, V., Bowler, J.V. (1993). Vascular dementia. Neurology, 43, 2159–2160.CrossRefGoogle ScholarPubMed
Hachinski, V., Iadecola, C., Petersen, R.C., Breteler, M.M., Nyenhuis, D.L., Black, S.E., Leblanc, G.G. (2006). National Institute of Neurological Disorders and Stroke – Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards. Stroke, 37, 2220–2241.CrossRefGoogle ScholarPubMed
Hachinski, V., Iliff, L.D., Zihlka, E., Du Boulay, G.H., McAllister, V.L., Marshall, J., Symon, L. (1975). Cerebral blood flow in dementia. Archives of Neurology, 32, 632–637.CrossRefGoogle ScholarPubMed
Hachinski, V., Lassen, J., Marshall, J. (1974). Multi-infarct dementia: A cause of mental deterioration in the elderly. Lancet, 2, 207–210.CrossRefGoogle ScholarPubMed
Hanley, J.A., McNeil, B.J. (1983). A method of comparing the areas under receiver operating characteristic curves. Radiology, 148, 839–843.CrossRefGoogle ScholarPubMed
Hughes, C.P., Berg, L., Danziger, W.L., Coben, L.A., Martin, R.L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry, 140, 566–572.CrossRefGoogle ScholarPubMed
Ihara, M., Okamoto, Y., Takahashi, R. (2012). Suitability of the Montreal Cognitive Assessment versus the Mini-Mental State Examination in detecting Vascular Cognitive Impairment. Journal of Stroke and Cerebrovascular Diseases. doi:10.1016/j.jstrocecerebrovasdis.2012.01.001 [Epub ahead of print].Google ScholarPubMed
Ihl, R., Frölich, T.D., Martin, E.M., Maurer, K. (1992). Differential validity of psychometric tests in dementia of Alzheimer type. Psychiatry Research, 44, 93–106.CrossRefGoogle Scholar
Ikeda, M., Hokoishi, K., Maki, N., Nebu, A., Tachibana, N., Komori, K., Tanable, H. (2001). Increased prevalence of vascular dementia in Japan: A community-based epidemiological study. Neurology, 57, 839–844.CrossRefGoogle ScholarPubMed
Ismail, Z., Rajji, T.K., Shulman, K.I. (2009). Brief cognitive screening instruments: An update. International Journal of Geriatric Psychiatry, 25(2), 111–120. doi:10.1002/gps.2306CrossRefGoogle Scholar
Jacova, C., Kertesz, A., Blair, M., Fisk, J.D., Feldman, H.H. (2007). Neuropsychological testing and assessment for dementia. Alzheimer's Dementia, 3(4), 299–317. doi:10.1016/j.jalz.2007.07.011CrossRefGoogle ScholarPubMed
Jorm, A., O'Brien, J. (2004). The epidemiology of vascular dementia: An overview and commentary. In J. O'Brien, D. Ames, L. Gustafson, M. Folstein, & E. Chiu (Eds.), Cerebrovascular disease, cognitive impairment and dementia (2nd ed., pp. 95–100). London: Martin Dunitz.Google Scholar
Lamar, M., Price, C.C., Giovannetti, T., Swenson, R., Libon, D.J. (2010). The dysexecutive syndrome associated with ischaemic vascular disease and related subcortical neuropathology: A Boston process approach. Behavioural Neurology, 22, 53–62. doi:10.3233/BEN-2009-0237CrossRefGoogle ScholarPubMed
Lobo, A., Launer, L.J., Fratiglioni, L., Andersen, K., Di Carlo, A., Breteler, M.M., Hofman, A. (2000). Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurology, 54(Suppl. 5), S4–S9.Google ScholarPubMed
Lobo, A., Martinez-Lage, J., Soininen, H., Hofman, A. (2000). Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurology, 54(Suppl. 5), S10–S15.Google ScholarPubMed
Lonie, J.A., Tierney, K.M., Ebmeier, K.P. (2009). Screening for Mild Cognitive Impairment: A systematic review. International Journal of Geriatric Psychiatry, 24(9), 902–915. doi:10.1002/gps.2208CrossRefGoogle ScholarPubMed
Looi, J.C., Sachdev, P.S. (1999). Differentiation of vascular dementia from AD on neuropsychological tests. Neurology, 53, 670–678.CrossRefGoogle ScholarPubMed
Martinić-Popović, I., Šerić, V., Demarin, V. (2006). Early detection of mild cognitive impairment in patients with cerebrovascular disease. Acta Clinica Croatica, 45, 77–85.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Moorhouse, P., Rockwood, K. (2008). Vascular cognitive impairment: Current concepts and clinical developments. Lancet Neurology, 7, 246–255.CrossRefGoogle ScholarPubMed
Mungas, D., Reed, B.R., Kramer, J.H. (2003). Psychometrically matched measures of global cognition, memory, and executive function for assessment of cognitive decline in older persons. Neuropsychology, 17(3), 380–392.CrossRefGoogle ScholarPubMed
Nasreddine, Z., Phillips, N.A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for Mild Cognitive Impairment. Journal of American Geriatrics Society, 53(4), 695–699.CrossRefGoogle Scholar
O'Brien, J., Reisberg, B., Erkinjuntti, T. (2003). Vascular burden of the brain. International Psychogeriatrics, 15(1), 7–10.CrossRefGoogle ScholarPubMed
Pendlebury, S.T., Cuthbertson, F.C., Welch, S.J., Mehta, Z., Rothwell, P.M. (2010). Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: A population-based study. Stroke, 41, 1290–1293.CrossRefGoogle ScholarPubMed
Pirscoveanu, D., Tudorica, V., Matcau, L., Zaharia, C., Matcau, D., Ene, L. (2009). Six months follow-up study on cognitive performances in patients with ischemic vascular events. Timisoara Medical, 59(1), 81–85.Google Scholar
Reed, B.R., Mungas, D.M., Kramer, J.H., Betz, B.P., Ellis, W., Vinters, H.V., Chui, H.C. (2004). Clinical and neuropsychological features in autopsy-defined vascular dementia. The Clinical Neuropsychologist, 18(1), 63–74.CrossRefGoogle ScholarPubMed
Román, G.C. (2003). Vascular dementia: Distinguishing characteristics, treatment, and prevention. Journal of American Geriatrics Society, 51, S296–S304.CrossRefGoogle ScholarPubMed
Román, G.C., Royall, D.R. (1999). Executive control function: A rational basis for the diagnosis of vascular dementia. Alzheimer's Disease & Associated Disorders, 13(Suppl. 3), S69–S80.CrossRefGoogle ScholarPubMed
Román, G.C., Tatemichi, T.K., Erkinjuntti, T., Cummings, J.L., Masdeu, J.C., Garcia, J.H., Scheinberg, P. (1993). Vascular dementia: Diagnostic criteria for research studies–Report of the NINDS-AIREN International Workshop. Neurology, 43, 250–260.CrossRefGoogle ScholarPubMed
Rosen, W.G., Mohs, R.C., Davis, K.L. (1984). A new rating scale for Alzheimer's Disease. American Journal of Psychiatry, 141, 1356–1364.Google ScholarPubMed
Santana, I. (2006). Demência Vascular [Vascular dementia]. In H. Firmino (Ed.), Psicogeriatria [Psychogeriatry] (pp. 413–426). Lisbon: Psiquiatria Clínica.Google Scholar
Schmand, B., Jonker, C., Hooijer, C., Lindeboom, J. (1996). Subjective memory complaints may announce dementia. Neurology, 46(1), 121–125.CrossRefGoogle ScholarPubMed
Simões, M. R., Freitas, S., Santana, I., Firmino, H., Martins, C., Nasreddine, Z., Vilar, M. (2008). Montreal Cognitive Assessment (MoCA): Versão portuguesa [Montreal Cognitive Assessment (MoCA): Portuguese version]. Coimbra, Portugal: Serviço de Avaliação Psicológica da Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra [Psychological Assessment Department, Faculty of Psychology and Educational Sciences, University of Coimbra].Google Scholar
Tombaugh, T.N., McIntyre, N.J. (1992). The Mini-Mental State Examination: A comprehensive review. Journal of American Geriatrics Society, 40, 922–935.CrossRefGoogle ScholarPubMed
Ueda, K., Kawano, H., Hasuo, Y., Fujishima, M. (1992). Prevalence and etiology of dementia in a Japanese community. Stroke, 23, 789–803.CrossRefGoogle Scholar
van Straaten, E.C., Scheltens, P., Knol, D.L., van Buchem, M.A., van Dijk, E.J., Hofman, P.A., Barkhof, F. (2003). Operational definitions for the NINDS-AIREN criteria for Vascular dementia. Stroke, 34, 1907–1912.CrossRefGoogle ScholarPubMed
Wind, A.W., Schellevis, F.G., van Staveren, G., Scholten, R.P., Jonker, C., van Eijk, J.T. (1997). Limitations of the Mini-Mental State Examination in diagnosing dementia in general practice. International Journal of Geriatric Psychiatry, 12, 101–108.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
Wong, A., Kwan, P., Chan, A., Lam, W., Nyenhuis, D., Nasreddine, Z., Wong, L. (2008). The validity, reliability and utility of the Cantonese Montreal Cognitive Assessment (MoCA) in Chinese patients with confluent white matter lesions. Hong Kong Medical Journal, 14(6), FP1.Google Scholar
Wong, A., Xiong, Y.Y., Kwan, P.W., Chan, A.Y., Lam, W.W., Wang, K., Mok, V.C. (2009). The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dementia and Geriatric Cognitive Disorders, 28, 81–87.CrossRefGoogle Scholar
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M., Leirer, V.O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37–49.CrossRefGoogle Scholar