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Improving precision in the quantification of cognition using the Montreal Cognitive Assessment and the Mini-Mental State Examination

Published online by Cambridge University Press:  01 February 2011

Lisa Koski ,
Haiqun Xie  and
Susanna Konsztowicz
Lisa Koski*
Affiliation:
Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada Divisions of Geriatrics and of Clinical Epidemiology, Department of Medicine, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
Haiqun Xie
Affiliation:
Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
Susanna Konsztowicz
Affiliation:
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
*
Correspondence should be addressed to: Dr. Lisa Koski, Royal Victoria Hospital, R4.74, 687 Pine Avenue West, Montreal, QC H3A 1A1, Canada. Phone: +1 514-934-1934, ext. 34420; Fax: +1 514-843-1734. Email: [email protected].
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Abstract

Background: The Montreal Cognitive Assessment (MoCA) can be used to quantify cognitive ability in older persons undergoing screening for cognitive impairment. Although highly sensitive in detecting mild cognitive impairment, its measurement precision is weakest among persons with milder forms of impairment. We sought to overcome this limitation by integrating information from the Mini-Mental State Examination (MMSE) into the calculation of cognitive ability.

Methods: Data from 185 geriatric outpatients screened for cognitive impairment with the MoCA and the MMSE were Rasch analyzed to evaluate the extent to which the MMSE items improved measurement precision in the upper ability ranges of the population.

Results: Adding information from the MMSE resulted in a 13.8% (13.3–14.3%) reduction in measurement error, with significant improvements in all quartiles of patient ability. The addition of three-word repetition and recall, copy pentagons, repeat sentence, and write sentence improved measurement of cognition in the upper levels of ability.

Conclusions: The algorithm presented here maximizes the yield of available clinical data while improving measurement of cognitive ability, which is particularly important for tracking changes over time in patients with milder levels of impairment.

Keywords

geriatriccognitive impairmentdementiameasurementRaschMoCAMMSE
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 7 , September 2011 , pp. 1107 - 1115
Copyright
Copyright © International Psychogeriatric Association 2011

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References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. Washington, DC: American Psychiatric Association.Google Scholar
Duro, D., Simoes, M. R., Ponciano, E. and Santana, I. (2009). Validation studies of the Portuguese experimental version of the Montreal Cognitive Assessment (MoCA): confirmatory factor analysis. Journal of Neurology, 257, 728–734.CrossRefGoogle ScholarPubMed
Elhan, A. H. et al. (2005). Psychometric properties of the Mini-Mental State Examination in patients with acquired brain injury in Turkey. Journal of Rehabilitation Medicine, 37, 306–311.CrossRefGoogle ScholarPubMed
Fujiwara, Y. et al. (2010). Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment. Geriatrics and Gerontology International, 10, 225–232.CrossRefGoogle ScholarPubMed
Hanna-Pladdy, B., Enslein, A., Fray, M., Gajewski, B. J., Pahwa, R. and Lyons, K. E. (2010). Utility of the NeuroTrax computerized battery for cognitive screening in Parkinson's disease: comparison with the MMSE and the MoCA. International Journal of Neuroscience, 120, 538–543.CrossRefGoogle ScholarPubMed
Koski, L., Xie, H. and Finch, L. (2009). Measuring cognition in a geriatric outpatient clinic: Rasch analysis of the Montreal Cognitive Assessment. Journal of Geriatric Psychiatry and Neurology, 22, 151–160.CrossRefGoogle Scholar
Lee, J. Y. et al. (2008). Brief screening for mild cognitive impairment in elderly outpatient clinic: validation of the Korean version of the Montreal Cognitive Assessment. Journal of Geriatric Psychiatry and Neurology, 21, 104–110.CrossRefGoogle ScholarPubMed
Nasreddine, Z. S. et al. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695–699.CrossRefGoogle Scholar
Pendlebury, S. T., Cuthbertson, F. C., Welch, S. J., Mehta, Z. and 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
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183–194.CrossRefGoogle ScholarPubMed
Schultz-Larsen, K., Kreiner, S. and Lomholt, R. K. (2007). Mini-Mental Status Examination: mixed Rasch model item analysis derived two different cognitive dimensions of the MMSE. Journal of Clinical Epidemiology, 60, 268–279.CrossRefGoogle ScholarPubMed
Tennant, A. et al. (2004). Assessing and adjusting for cross-cultural validity of impairment and activity limitation scales through differential item functioning within the framework of the Rasch model: the Pro-ESOR project. Medical Care, 42, 37–48.CrossRefGoogle ScholarPubMed
Wen, H. B., Zhang, Z. X., Niu, F. S. and Li, L. (2008). [The application of Montreal Cognitive Assessment in urban Chinese residents of Beijing]. Zhonghua Nei Ke Za Zhi [Chinese Journal of Internal Medicine], 47, 36–39.Google ScholarPubMed
Wolfe, E. W. and Smith, E. V. Jr. (2007). Instrument development tools and activities for measure validation using Rasch models. Part II: validation activities. Journal of Applied Measurement, 8, 204–234.Google ScholarPubMed
Wouters, H., van Gool, W. A., Schmand, B., Zwinderman, A. H. and Lindeboom, R. (2010). Three sides of the same coin: measuring global cognitive impairment with the MMSE, ADAS-cog and CAMCOG. International Journal of Geriatric Psychiatry, 25, 770–779.CrossRefGoogle ScholarPubMed