title: Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy.
abstract: To determine if Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting cognitive abnormalities in patients with probable progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) compared with Parkinson's disease (PD). In this multicenter observational study, MMSE and MoCA were administered in a random order to 130 patients: 35 MSA, 30 PSP and 65 age, and education and gender matched-PD. We assessed between-group differences for MMSE, MoCA, and their subitems. Receiver-operating characteristic (ROC) curves were calculated. The mean MMSE was higher than the mean MoCA score in each MSA (27.7 ± 2.4 vs. 22.9 ± 3.0, p < 0.0001), PSP (26.0 ± 2.9 vs. 18.2 ± 3.9, p < 0.0001), and PD (27.3 ± 2.0 vs. 22.3 ± 3.5, p < 0.0001). MoCA total score as well as its letter fluency subitem differentiated PSP from MSA and PD with high specificity and moderate sensitivity. More specifically, a cut-off score of 7 F-words or less per minute would support a diagnosis of PSP (PSP vs. PD: 86 % specificity, 70 % sensitivity; PSP vs. MSA: 71 % specificity, 70 % sensitivity). By contrast, MMSE presented an overall ceiling effect for most subitems, except for the pentagon scores, where PSP did less well than MSA or PD patients. These preliminary results suggest that PSP and MSA, similar to PD patients, may present normal MMSE and reduced MoCA performance. Overall, MoCA is more sensitive than MMSE in detecting cognitive impairment in atypical parkinsonism and together with verbal fluency would be a useful test to support PSP diagnosis.
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, "Fondazione Ospedale San Camillo"-I.R.C.C.S., Via Alberoni, 70, 30126, Venice-Lido, Italy. eleonora.fiorenzato@gmail.com.|Department of General Psychology, University of Padua, Padua, Italy. eleonora.fiorenzato@gmail.com.
authors.forename: Eleonora
authors.identifier: http://orcid.org/0000-0001-7947-5903
authors.initials: E
authors.lastname: Fiorenzato
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, "Fondazione Ospedale San Camillo"-I.R.C.C.S., Via Alberoni, 70, 30126, Venice-Lido, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Weis
authors.affiliation: Faculty of Medicine, Transilvania University, Brasov, Romania.|Department of Neurology, County Emergency Clinic Hospital, Brasov, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Falup-Pecurariu
authors.affiliation: Department of Neurology, County Emergency Clinic Hospital, Brasov, Romania.
authors.forename: Stefania
authors.initials: S
authors.lastname: Diaconu
authors.affiliation: Parkinson Institute, ASST G. Pini-CTO, ex ICP, Milan, Italy.|Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Siri
authors.affiliation: Parkinson Institute, ASST G. Pini-CTO, ex ICP, Milan, Italy.|Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Reali
authors.affiliation: Parkinson Institute, ASST G. Pini-CTO, ex ICP, Milan, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Pezzoli
authors.affiliation: Department of General Psychology, University of Padua, Padua, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Bisiacchi
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, "Fondazione Ospedale San Camillo"-I.R.C.C.S., Via Alberoni, 70, 30126, Venice-Lido, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, "Fondazione Ospedale San Camillo"-I.R.C.C.S., Via Alberoni, 70, 30126, Venice-Lido, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Biundo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D000073216:Mental Status and Dementia Tests; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications* / Q000175:diagnosis; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis; D012372:ROC Curve; D013494:Supranuclear Palsy, Progressive / Q000150:complications* / Q000175:diagnosis
keywords: Cognition; Mini-Mental State Examination (MMSE); Montreal Cognitive Assessment (MoCA); Multiple system atrophy (MSA); Parkinson disease (PD); Progressive supranuclear palsy (PSP)