The montreal cognitive assessment and the mini-mental state examination as screening instruments for cognitive impairment: Item analyses and threshold scores

Anne M. Damian, Sandra A. Jacobson, Joseph G. Hentz, Christine M. Belden, Holly A. Shill, Marwan N. Sabbagh, John N. Caviness, Charles H. Adler

Research output: Contribution to journalArticlepeer-review

161 Scopus citations

Abstract

Aims: To perform an item analysis of the Montreal Cognitive Assessment (MoCA) versus the Mini-Mental State Examination (MMSE) in the prediction of cognitive impairment, and to examine the characteristics of different MoCA threshold scores. Methods: 135 subjects enrolled in a longitudinal clinicopathologic study were administered the MoCA by a single physician and the MMSE by a trained research assistant. Subjects were classified as cognitively impaired or cognitively normal based on independent neuropsychological testing. Results: 89 subjects were found to be cognitively normal, and 46 cognitively impaired (20 with dementia, 26 with mild cognitive impairment). The MoCA was superior in both sensitivity and specificity to the MMSE, although not all MoCA tasks were of equal predictive value. A MoCA threshold score of 26 had a sensitivity of 98% and a specificity of 52% in this population. In a population with a 20% prevalence of cognitive impairment, a threshold of 24 was optimal (negative predictive value 96%, positive predictive value 47%). Conclusion: This analysis suggests the potential for creating an abbreviated MoCA. For screening in primary care, the MoCA threshold of 26 appears optimal. For testing in a memory disorders clinic, a lower threshold has better predictive value.

Original languageEnglish (US)
Pages (from-to)126-131
Number of pages6
JournalDementia and geriatric cognitive disorders
Volume31
Issue number2
DOIs
StatePublished - Mar 2011

Keywords

  • Alzheimer's disease
  • Mild cognitive impairment
  • Mini-Mental State Examination
  • Montreal Cognitive Assessment

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Cognitive Neuroscience
  • Psychiatry and Mental health

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