Objective: To compare the utility for detecting Mild Cognitive Impairment in Parkinson’s disease (PD-MCI) of three abbreviated global scales: the Montreal Cognitive Assessment (MoCA), the Parkinson’s disease-Cognitive Rating Scale (PD-CRS) and the Addenbrooke’s Cognitive Examination new version (ACE-III).

Background: The Movement Disorders Society (MDS) proposed guidelines for diagnosing PD-MCI including two assessment levels: abbreviated (Level-I) and comprehensive (Level-II). The availability of cognitive scales adapted to new MDS criteria with high discriminative abilities can improve the precision of PD-MCI identification in a clinical setting.

Methods: The study sample included early PD patients (≤5 years from diagnosis) with normal cognition (PD-NC) or PD-MCI based on Level-II MDS criteria (two tests within each cognitive domain). Receiver operator curve (ROC) analyses were generated to calculate the area under the curve (AUC) and to measure the sensitivity and specificity of the cutoff scores from the Level-I scales. To examine the utility as screening tools, the optimal cutoff was defined as the lowest value providing ≥80% sensitivity (SEN). To use them as diagnostic tools, the optimal cutoff was the highest value providing ≥80% specificity (SPE).

Results: After screening for inclusion criteria, 71 PD patients [53.5% males; age= 68.7 (10.0SD) years; education=11.5 (4.9SD) years; PD evolution= 2.0 (1.7SD) years] completed the assessment.

Demographical and clinical data

	Total (n=71)	PD-NC (n=51)	PD-MCI (n=20)	P value t-test (PD-NC vs PD-MCI)
	mean (SD)	mean (SD)	mean (SD)
Age (years)	68.7 (10.0)	66.9 (10.6)	73.0 (6.7)	0.006
Gender, n Males (%)	38 (53.5)	29 (56.9)	9 (45.0)	N.S
Education (years)	11.5 (4.9)	12.2 (4.4)	9.7 (5.8)	N.S
PD Evolution (years)	2.0 (1.7)	1.9 (1.7)	2.0 (1.8)	N.S
HADS Depression	3.2 (3.1)	3.1 (2.8)	3.7 (3.8)	N.S
HADS Anxiety	5.2 (4.1)	5.5 (4.2)	9.4 (7.4)	N.S
PD-CFRS	1.7 (1.9)	1.3 (1.8)	2.8 (2.0)	0.004

HADS = Hospital Anxiety and Depression Scale; PD-CFRS = Parkinson’s disease – Cognitive Functional Rating Scale” Twenty patients were diagnosed as PD-MCI (28.2%) and 51 as PD-NC.

Cognitive Assessment results

Task (max)	PD-NC (n=51)	PD-MCI (n=20)	P value
MDS Level-I	mean (SD)	mean (SD)
MoCA (30)	25.9 (2.8)	21.9 (3.2)	<0.001
PD-CRS (134)	94.8 (12.2)	72.2 (9.0)	<0.001
ACE-III (100)	91.7 (6.8)	80.0 (8.3)	<0.001
MDS Level-II
Attention & WM
TMT-A (sg)	52.2 (17.3)	90.6 (32.3)	<0.001
Digits Backward (max span)	3.9 (0.9)	2.9 (0.8)	<0.001
Executive Function
TMT-B (sg)	137.3 (69.1)	341.1 (144.1)	<0.001
Phonetic Fluency	16.2 (4.3)	10.9 (3.9)	<0.001
Memory
FCSRT DFR	9.6 (3.4)	5.2 (3.1)	<0.001
ROCF 30′	12.7 (6.7)	5.1 (4.3)	<0.001
Language
BNT	54.5 (4.1)	49.7 (4.7)	<0.001
Semantic Fluency	19.9 (5.7)	13.8 (4.5)	<0.001
Visuospatial Function
JLOT	21.6 (4.8)	16.4 (5.3)	<0.001
VOSP Number Location	8.1 (1.3)	7.2 (2.5)	0.07 N.S.

TMT= Trail Making Test; FCSRT DFR= Free and Cued Selective Remining Test delayed free recall; ROCF= Rey-Osterrieth Complex Figure; BNT= Boston Naming Test; JLOT= Judgment of Line Orientation Test; VOSP= Visual Object and Space Perception battery PD-MCI group was significantly older and presented a worst performance in every cognitive measure. ROC analyses for the ACE-III (AUC=0.874) showed that the optimal cutoff score for PD-MCI screening was <89/100 (SEN=0.80; SPE=0.76) and for diagnostic purposes was <88/100 (SEN=0.75; SPE=0.84). For the MoCA (AUC=0.820) the optimal cutoff score for screening was <25/30 (SEN=0.80; SPE=0.74) and for diagnostic purposes was <24/30 (SEN=0.70; SPE=0.80). For the PD-CRS (AUC=0.930) a total score of <83/134 for global purposes yielded the best balance (SEN=0.80; SPE=0.82).

Conclusions: The PD-CRS shows the best performance as a diagnostic tool for PD-MCI, compared to the MoCA and the ACE-III results. These findings support the MDS recommendation allowing the application of an abbreviated assessment option to identify PD-MCI in non-demented PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-the-utility-of-three-cognitive-scales-for-mds-level-i-diagnosis-of-mild-cognitive-impairment-in-parkinsons-disease-moca-pd-crs-and-ace-iii/