title: The Montreal Cognitive Assessment and the mini-mental state examination as screening instruments for cognitive impairment: item analyses and threshold scores.
abstract: OBJECTIVE
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Arizona College of Medicine Phoenix Campus, Phoenix, AZ, USA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Damian
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Jacobson
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Hentz
authors.forename: Christine M
authors.initials: CM
authors.lastname: Belden
authors.forename: Holly A
authors.initials: HA
authors.lastname: Shill
authors.forename: Marwan N
authors.initials: MN
authors.lastname: Sabbagh
authors.forename: John N
authors.initials: JN
authors.lastname: Caviness
authors.forename: Charles H
authors.initials: CH
authors.lastname: Adler
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology*; D003704:Dementia / Q000209:etiology / Q000523:psychology; D015140:Dementia, Vascular / Q000523:psychology; D005260:Female; D006801:Humans; D020961:Lewy Body Disease / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology; D012372:ROC Curve; D012016:Reference Values