Objective: To investigate the ability of the Montreal Cognitive Assessment (MoCA) to detect mild cognitive impairment (MCI) in Parkinson’s disease (PD) using variations in cognitive impairment criteria.

Background: The MoCA is a screening tool reported to have high sensitivity (90%) and specificity (87%) for detecting MCI when using a suggested cut-off score of 26 [1]. In relation to PD, the MoCA has shown varying success at detecting MCI when using a cut-off score of 26 [2-4], with lower cut-off scores suggested [5]. Variations in the definition of cognitive impairment may impact the performance of the MoCA. Although the MDS Task Force criteria [6] for PD-MCI are widely used, emerging evidence shows that a more conservative approach to designating impairment may optimize predictions of progression to dementia in PD [7].

Method: 140 individuals with idiopathic PD participating in a multi-site longitudinal, observational cohort study were classified as being cognitively normal, or having PD-MCI or dementia using a neuropsychological test battery and applying 1) MDS Task Force – Level II criteria, and 2) a conservative variation, whereby at least two impairments within a single cognitive domain was required. The performance of the MoCA for correctly classifying participants with PD-MCI was investigated.

Results: With the MDS criteria, 48 participants were classified as cognitively normal and 56 met criteria for PD-MCI, with memory (80%), attention (66%), and executive cognition (61%) being the most commonly impaired domains. The traditional MoCA cut-off score of ≥26 resulted in 59% sensitivity and 83% specificity. The lowest cut-off level that provided at least 80% sensitivity was ≥28; with 48% specificity. Using the conservative approach, fewer participants were classified as PD-MCI (n=42), with memory (48%) and executive (45%) impairments equally represented but at lower rates. The traditional MoCA cut-off score applied here resulted in 64% sensitivity and 78% specificity. Again, the lowest cut-off score to provide at least 80% sensitivity was ≥28, resulting in 44% specificity.

Conclusion: Results are consistent with previous findings that show the MoCA is not ideal for detecting cognitive impairment in PD-MCI. Of interest, slight variations in PD-MCI criteria significantly impact prevalence rates and cognitive profiles of PD-MCI, but did not improve the utility of the MoCA.

References: [1] Nasreddine et al. (2005). Journal of the American Geriatrics Society, 53, 695-699. doi:10.1111/j.1532-5415.2005.53221.x [2] Dalrymple-Alford et al. (2010). Neurology, 75, 1717-1725. doi: 10.1212/WNL.0b013e3181fc29c9 [3] Kandiah et al. (2014). Parkinsonism & Related Disorders, 20, 1145-1148. doi: 10.1016/j.parkreldis.2014.08.002 [4] Marras et al. (2013). Movement Disorders, 28, 626-633. doi: 10.1002/mds.25426 [5] Lucza et al. (2015). Behavioural Neurology, 2015, 983606. doi: 10.1155/2015/983606 [6] Litvan et al. (2012). Movement Disorders, 27, 349-356. doi: 10.1002/mds.24893 [7] Wood et al. (2016). NPJ Parkinson’s disease, 2, 15027. doi:10.1038/npjparkd.2015.27

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MDS Abstracts - https://www.mdsabstracts.org/abstract/accuracy-of-the-moca-in-detecting-pd-mci-in-the-ontario-neurodegenerative-disease-research-initiative-study/