title: Screening for Mild Cognitive Impairment: Comparison of "MCI Specific" Screening Instruments.
abstract: BACKGROUND
  Sensitive and specific instruments are required to screen for cognitive impairment (CI) in busy clinical practice. The Montreal Cognitive Assessment (MoCA) is widely validated but few studies compare it to tests designed specifically to detect mild cognitive impairment (MCI).
  
  
  OBJECTIVE
  Comparison of two "MCI specific" screens: the Quick Mild Cognitive Impairment screen (Qmci) and MoCA.
  
  
  METHODS
  Patients with subjective memory complaints (SMC; n = 73), MCI (n = 103), or dementia (n = 274), were referred to a university hospital memory clinic and underwent comprehensive assessment. Caregivers, without cognitive symptoms, were recruited as normal controls (n = 101).
  
  
  RESULTS
  The Qmci was more accurate than the MoCA in differentiating MCI from controls, area under the curve (AUC) of 0.90 versus 0.80, p = 0.009. The Qmci had greater (AUC 0.81), albeit non-significant, accuracy than the MoCA (AUC 0.73) in separating MCI from SMC, p = 0.09. At its recommended cut-off (<62/100), the Qmci had a sensitivity of 90% and specificity of 87% for CI (MCI/dementia). Raising the cut-off to <65 optimized sensitivity (94%), reducing specificity (80%). At <26/30 the MoCA had better sensitivity (96%) but poor specificity (58%). A MoCA cut-off of <24 provided the optimal balance. Median Qmci administration time was 4.5 (±1.3) minutes compared with 9.5 (±2.8) for the MoCA.
  
  
  CONCLUSIONS
  Although both tests distinguish MCI from dementia, the Qmci is particularly accurate in separating MCI from normal cognition and has shorter administration times, suggesting it is more useful in busy hospital clinics. This study reaffirms the high sensitivity of the MoCA but suggests a lower cut-off (<24) in this setting.
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland.|Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland.
authors.forename: Rónán
authors.initials: R
authors.lastname: O'Caoimh
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Timmons
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland.
authors.forename: D William
authors.initials: DW
authors.lastname: Molloy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D003704:Dementia / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010465:Perception; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013997:Time Factors
keywords: Cognitive screening; Montreal Cognitive Assessment; Quick Mild Cognitive Impairment screen; dementia; mild cognitive impairment