title: The MoCA and MMSE as screeners for cognitive impairment in a heart failure population: a study with comprehensive neuropsychological testing.
abstract: OBJECTIVE
  To examine the ability of the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to detect cognitive impairment in persons with heart failure (HF).
  
  
  BACKGROUND
  Although the MMSE and MoCA are commonly used screeners in HF, no research team has validated their performance against neuropsychological testing.
  
  
  METHODS
  Participants were 106 patients with HF (49.1% male, 68.13 ± 9.82 years) who completed the MoCA, MMSE, and a full neuropsychological battery. Sensitivity and specificity were examined. Discriminant function analyses tested whether the screeners correctly detected cognitive impairment.
  
  
  RESULTS
  A MoCA score <25 and MMSE score of <28 yielded optimal sensitivity/specificity (.64/.66 and .70/.66, respectively). The MoCA correctly classified 65% of patients, Wilk's lambda = .91, χ(2)(1) = 9.89, p < .01, and the MMSE correctly classified 68%, Wilk's lambda = .87, χ(2)(1) = 14.26, p < .001.
  
  
  CONCLUSIONS
  In HF, both the MoCA and MMSE are useful in identifying the majority of patients with and without cognitive impairment. Both tests misclassified approximately one-third of patients, so continued monitoring and evaluation of patients is needed in conjunction with screening.
authors.affiliation: Department of Psychological Sciences, Kent State University, Kent, OH 44242, USA. Electronic address: mhawki15@kent.edu.
authors.forename: Misty A W
authors.initials: MA
authors.lastname: Hawkins
authors.affiliation: Department of Psychological Sciences, Kent State University, Kent, OH 44242, USA.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Gathright
authors.affiliation: Department of Psychological Sciences, Kent State University, Kent, OH 44242, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Dolansky
authors.affiliation: Cardiovascular Institute, Summa Health System, Akron City Hospital, Akron, OH 44307, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Redle
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA; Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Josephson
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA.
authors.forename: Shirley M
authors.initials: SM
authors.lastname: Moore
authors.affiliation: Department of Psychological Sciences, Kent State University, Kent, OH 44242, USA; Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, OH 44307, USA.
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hughes
mesh_terms: D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012680:Sensitivity and Specificity
keywords: Cognitive impairment; Heart failure; MMSE; MoCA; Screening