Share this Article
Ng A, Chew I, Narasimhalu K, Kandiah N
Correspondence: Dr Nagaendran Kandiah, Nagaendran_Kandiah@nni.com.sg
INTRODUCTION Mild cognitive impairment (MCI) is an important clinical entity with significant management implications. However, traditional screening tools lack the sensitivity needed to detect amnestic MCI (MCI-A). Montreal Cognitive Assessment (MoCA) has yet to be validated for the diagnosis of MCI in a multiracial society such as Singapore. We thus aimed to study the effectiveness of MoCA for the diagnosis of MCI-A in the Singapore population.
METHODS Data on patients with MCI-A and mild Alzheimer’s disease (AD) was obtained from a prospectively collected clinical database between January 2008 and January 2011. Patients with no cognitive impairment (NCI) were recruited from among the spouses and friends of patients attending the memory clinic.
RESULTS There were a total of 212 participants (103 NCI, 49 MCI-A, 60 mild AD). For the diagnosis of MCI-A, a MoCA score of < 26 for patients with ≤ 10 years of education, and a score of < 27 for patients with > 10 years of education provided a sensitivity of > 94%. For the diagnosis of mild AD, a MoCA score of < 24 for patients with ≤ 10 years of education, and a score of < 25 for patients with > 10 years of education provided a sensitivity of > 85%.
CONCLUSION In the Singapore population, we recommend cutoff scores of 26/27 and 24/25 be used to detect MCI-A and mild AD, respectively, when using MoCA. For patients with ≤ 10 years of education, a +1 point correction is needed.
Keywords: dementia, mild Alzheimer’s disease, mild cognitive impairment, neuropsychological assessment
Singapore Med J 2013; 54(11): 616-619; http://dx.doi.org/10.11622/smedj.2013220
| 1. Chertkow H, Massoud F, Nasreddine Z, et al. Diagnosis and treatment of dementia: 3. Mild cognitive impairment and cognitive impairment without dementia. CMAJ 2008; 178:1273-85. |
| 2. Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56:303-8. |
| 3. Grundman M, Petersen RC, Ferris SH, et al. Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol 2004; 61:59-66. |
|4. Sherwin BB. Mild cognitive impairment: potential pharmacological treatment options. J Am Geriatr Soc 2000; 48:431-41.|
| 5. Wind AW, Schellevis FG, Van Staveren G, et al. Limitations of the MiniMental State Examination in diagnosing dementia in general practice. Int J Geriatr Psychiatry 1997; 12:101-8. |
| 6. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53:695-9. |
| 7. Lee JY, Lee DW, Cho SJ, et al. Brief screening for mild cognitive impairment in elderly outpatient clinic: validation of the Korean version of the Montreal Cognitive Assessment. J Geriatr Psychiatry Neurol 2008; 21:104-10. |
|8. Wen HB, Zhang ZX, Niu FS, Li L. [The application of Montreal cognitive assessment in urban Chinese residents of Beijing]. Zhonghua Nei Ke Za Zhi 2008; 47:36-9. Chinese.|
| 9. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician". J Psychiatr Res 1975; 12:189-98. |
| 10. Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 1986; 5:165-73. |
| 11. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984; 34:939-44. |
| 12. Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993; 43:2412-4. |
| 13. Fujiwara Y, Suzuki H, Yasunaga M, et al. Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment. Geriatr Gerontol Int 2010; 10:225-32. |
| 14. Luis CA, Keegan AP, Mullan M. Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry 2009; 24:197-201. |