title: Montreal cognitive assessment in assessing clinical severity and white matter hyperintensity in Alzheimer's disease with normal control comparison.
abstract: OBJECTIVE
  Use Taiwanese version of the Montreal Cognitive Assessment (MoCA) in evaluating patients in different stages of Alzheimer's disease (AD) and correlate with white matter change.
  
  
  METHODS
  Ninety-seven normal controls (NC), 52 very-mild AD (clinical dementia rating [CDR] = 0.5), 48 mild AD (CDR = 1) and 38 moderate AD (CDR = 2) patients were enrolled for the MoCA, Mini- Mental State Examination (MMSE) and the Cognitive Assessment Screening Instrument (CASI). White matter hyperintensities (WMHs) on brain MRI were visually rated and classified as deep or periventricular WMHs.
  
  
  RESULTS
  In NC group, education (β = 0.326) but not age (β = -0.183, p = 0.069), was significantly related to MoCA score. However, while we added two points to the AD patients with less than 6 years education, the effects of education disappeared as compared with those of 7 years of education. For all educational levels, the cutoff value of MoCA for very-mild AD was 22/23 (sensitivity = 82.7%, specificity = 87.6%). No significant differences were found in the areas under the curves that differentiated NC from the patients with AD for MoCA and MMSE (differences = 0.008, p = 0.490), or for MoCA and CASI (differences = 0.023, p = 0.082). Total WMHs, frontal deep and periventricular WMHs were inversely correlated with the attention and delayed-recall subdomain.
  
  
  CONCLUSIONS
  The MoCA is a good clinical tool for screening very-mild stage AD if the educational effects are carefully considered. The correlation between the executive subdomains with the frontal WMHs also makes it a useful tool for detecting subtle WMHs.
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ya-Ting
authors.initials: YT
authors.lastname: Chang
authors.forename: Chiung-Chih
authors.initials: CC
authors.lastname: Chang
authors.forename: Hung-Sheng
authors.initials: HS
authors.lastname: Lin
authors.forename: Chi-Wei
authors.initials: CW
authors.lastname: Huang
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Lui
authors.forename: Chen-Chang
authors.initials: CC
authors.lastname: Lee
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Lin
authors.forename: Chang-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Nai-Ching
authors.initials: NC
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000473:pathology; D001921:Brain / Q000473:pathology*; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009483:Neuropsychological Tests; D012372:ROC Curve; D013624:Taiwan