Abbreviated and Expanded Forms of the Montreal Cognitive Assessment for Dementia Screening
Horton, Daniel Kevin
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Cognitive screening is becoming increasingly important as the general population ages and the prevalence of dementia rises. However, popular cognitive screening tools have been criticized for their insensitivity to subtle cognitive impairment, poor specificity, excessive administration time, and/or questionable methods of test development. The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument growing in popularity which has demonstrated increased sensitivity to mild cognitive impairment (MCI), but takes roughly 10-15 minutes to administer and was developed without an empirically-driven item selection process. We devised two studies to address common limitations of cognitive screening tools using the MoCA. The aim of Study 1 was to create a short form of the MoCA (SF-MoCA) including only the items found to be most sensitive to MCI and Alzheimer disease (AD) and compare the diagnostic classification accuracy of the SF-MoCA to the Mini-Mental State Examination (MMSE) and standard MoCA. Results revealed delayed recall, orientation, and serial subtraction items to be most useful in differentiating the diagnostic groups. Overall, diagnostic accuracy of the SF-MoCA was superior to the MMSE and comparable to the standard MoCA, suggesting that some MoCA items do not add to the sensitivity of the instrument in these populations. Given the brevity and sensitivity of the SF-MoCA, we suggested this measure may be useful for early detection of cognitive impairment in primary care and other settings where evaluation time is limited. Despite the advantages of the SF-MoCA, this tool only assesses three cognitive domains and may not be appropriate in settings where clinicians may want to efficiently assess additional domains affected in AD and MCI to gain a clearer picture of global functioning and assist in differential diagnosis. Therefore, we conducted a second study to determine if diagnostic accuracy of the SF-MoCA might be enhanced through the addition of several brief and well-validated neuropsychological measures shown to be sensitive to cognitive impairment. Results revealed that the addition of measures of processing speed, category fluency, and verbal recall resulted in an Expanded SF-MoCA with diagnostic classification accuracy superior to both the standard MoCA and SF-MoCA. Findings of these studies have implications for current cognitive screening procedures and techniques used to develop these tools.