title: Comparison of two commonly used clinical cognitive screening tests to diagnose mild cognitive impairment in heart failure with the golden standard European Consortium Criteria.
abstract: BACKGROUND
  This study on mild cognitive impairment (MCI) in heart failure (HF) compares the utility of Montreal Cognitive Assessment (MoCA) to the Mini-Mental Status Exam (MMSE) for diagnosing MCI in a HF population when compared to the golden standard European Consortium Criteria (ECC).
  
  
  METHODS
  Participants were recruited from the Alberta HEART study at the Mazankowski Alberta Heart Institute in Edmonton and St. Mary's hospital in Camrose. This study enrolled 53 community adults aged>50years: 33 HF and 20 controls. Participants were assessed using both the MMSE and MoCA for MCI. MCI was diagnosed using the golden standard, European Consortium Criteria. Sensitivity and specificity analysis, positive and negative predictive values, likelihood ratios and kappa statistic were calculated.
  
  
  RESULTS
  The mean age was 72.8years (SD 8.4), 60.4% were females and 34% had underlying ischemic heart disease. Overall, two thirds of patients (22/33, 66%) with HF had MCI. In comparison to European Consortium Criteria, the sensitivity and specificity of MoCA were 82% and 91% in identifying individuals with MCI, and MMSE were 9% and 91%, respectively. The positive and negative predictive values for MoCA were 95% and 71%, and for MMSE were 67% and 33%, respectively. Kappa statistics showed good agreement between MoCA and consortium criteria (kappa=0.68) and a low agreement between MMSE and consortium criteria (kappa=0.07).
  
  
  CONCLUSIONS
  Cognitive dysfunction is common in patients with HF. Overall, the MoCA seems to be a better screening tool than MMSE for MCI in HF patients.
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada. Electronic address: ka9@ualberta.ca.
authors.forename: Kannayiram
authors.initials: K
authors.lastname: Alagiakrishnan
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Mah
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Jason R B
authors.initials: JR
authors.lastname: Dyck
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Canada.
authors.forename: Ambikaipakan
authors.initials: A
authors.lastname: Senthilselvan
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Justin
authors.initials: J
authors.lastname: Ezekowitz
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D003071:Cognition / Q000502:physiology*; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D015994:Incidence; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards*; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Delirium; Dementia; Heart failure; Mild cognitive impairment