title: Montreal Cognitive Assessment 5-minute protocol is a brief, valid, reliable, and feasible cognitive screen for telephone administration.
abstract: OBJECTIVE
  The National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization working group proposed a brief cognitive protocol for screening of vascular cognitive impairment. We investigated the validity, reliability, and feasibility of the Montreal Cognitive Assessment 5-minute protocol (MoCA 5-minute protocol) administered over the telephone.
  
  
  METHODS
  Four items examining attention, verbal learning and memory, executive functions/language, and orientation were extracted from the MoCA to form the MoCA 5-minute protocol. One hundred four patients with stroke or transient ischemic attack, including 53 with normal cognition (Clinical Dementia Rating, 0) and 51 with cognitive impairment (Clinical Dementia Rating, 0.5 or 1), were administered the MoCA in clinic and a month later, the MoCA 5-minute protocol over the telephone.
  
  
  RESULTS
  Administration of the MoCA 5-minute protocol took 5 minutes over the telephone. Total score of the MoCA 5-minute protocol correlated negatively with age (r=-0.36; P<0.001) and positively with years of education (r=0.41; P<0.001) but not with sex (ρ=0.03; P=0.773). Total scores of the MoCA and MoCA 5-minute protocol were highly correlated (r=0.87; P<0.001). The MoCA 5-minute protocol performed equally well as the MoCA in differentiating patients with cognitive impairment from those without (areas under receiver operating characteristics curve for MoCA 5-minute protocol, 0.78; MoCA=0.74; P>0.05 for difference; Cohen d for group difference, 0.80-1.13). It differentiated cognitively impaired patients with executive domain impairment from those without (areas under receiver operating characteristics curve, 0.89; P<0.001; Cohen d=1.7 for group difference). Thirty-day test-retest reliability was excellent (intraclass correlation coefficient, 0.89).
  
  
  CONCLUSIONS
  The MoCA 5-minute protocol is a free, valid, and reliable cognitive screen for stroke and transient ischemic attack. It is brief and highly feasible for telephone administration.
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
authors.forename: David
authors.initials: D
authors.lastname: Nyenhuis
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Black
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
authors.forename: Lorraine S N
authors.initials: LS
authors.lastname: Law
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
authors.forename: Eugene S K
authors.initials: ES
authors.lastname: Lo
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
authors.forename: Pauline W L
authors.initials: PW
authors.lastname: Kwan
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
authors.forename: Lisa
authors.initials: L
authors.lastname: Au
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
authors.forename: Anne Y Y
authors.initials: AY
authors.lastname: Chan
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
authors.forename: Lawrence K S
authors.initials: LK
authors.lastname: Wong
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
authors.forename: Ziad
authors.initials: Z
authors.lastname: Nasreddine
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.). vctmok@cuhk.edu.hk.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mok
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards*; D011594:Psychometrics / Q000295:instrumentation*; D015203:Reproducibility of Results; D020521:Stroke / Q000150:complications*; D017216:Telemedicine / Q000379:methods*; D013689:Telephone
keywords: neuropsychology; stroke; telephone