title: Diagnostic Accuracy and Confidence in the Clinical Detection of Cognitive Impairment in Early-Stage Parkinson Disease.
abstract: OBJECTIVE
  Mild cognitive impairment (MCI) is present in up to 34% of patients with early-stage Parkinson disease (PD); however, it is difficult to detect subtle impairment without objective cognitive testing.
  
  
  METHODS
  Data were obtained from the Parkinson Progression Marker Initiative. All 341 participants were administered the Montreal Cognitive Assessment (MoCA) and a brief neuropsychological battery. Participants were classified as PD-MCI if MoCA was <26 or if they scored ≥1 standard deviation below the normative mean in 2 or more domains, based upon established criteria. The sensitivity/specificity for the clinical detection of PD-MCI was determined.
  
  
  RESULTS
  Overall accuracy for clinical detection of PD-MCI was 67.4%. Although clinical determination was highly specific (96.3%; 95% confidence interval [CI]: 0.92-0.98), sensitivity was poor (32.0%; 95% CI: 0.25-0.40).
  
  
  CONCLUSIONS
  Identifying MCI in early-stage PD based on clinical interview alone appears to be insufficient. The inclusion of objective cognitive tests allowing for normative sample comparisons is needed to increase the detection of cognitive impairment in this population.
authors.affiliation: 1 Department of Neurology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Wyman-Chick
authors.affiliation: 2 Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS, USA.
authors.forename: Phillip K
authors.initials: PK
authors.lastname: Martin
authors.affiliation: 1 Department of Neurology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Barrett
authors.affiliation: 1 Department of Neurology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Manning
authors.affiliation: 1 Department of Neurology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Sperling
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications* / Q000523:psychology*; D012680:Sensitivity and Specificity
keywords: Parkinson disease; cognitive impairment; cognitive testing; movement disorder; neuropsychological testing