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Analysis of psychometric features of the Mini-Mental State Examination and the Montreal Cognitive Assessment methods
| Content Provider | Semantic Scholar |
|---|---|
| Author | Kabátová, Oľga Putekova, Silvia Martínková, Jana Súkenníková, M. |
| Copyright Year | 2016 |
| Abstract | This study aim was to analyse selected psychometric features of the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MoCA) methods. The Montreal Cognitive Assessment (MoCA) was developed to enable earlier detection of mild cognitive impairment (MCI) relative to familiar multi-domain tests like the Mini-Mental State Exam (MMSE). Clinicians need to better understand the relationship between MoCA and MMSE scores.The analysis was performed on a sample of 84 geriatric patients. We have found a concurrent validity by calculation of Pearson’s correlation coefficient between the test scores of the MMSE and the MoCA methods (r (84) = 0.77, P < 0.001). Based on the correlation analysis, it may be stated that the MMSE test score is in a very tight positive correlation with the test score of the MoCA. We have also performed reliability analysis of both screening methods by calculation of internal consistency. The internal consistency of the MMSE method was represented by Cronbach’s alpha at the level of 0.78, and the MoCA method at the level of 0.81; those are considered to be optimum Original Articles 63 Original Articles Clinical Social Work and Health Intervention Vol. 7 No. 2 2016 Introduction Cognitive disorders and dementia represent a serious health issue of older population. Due to high financial costs and social consequences they are becoming an issue of the whole society as well. Their prevalence is high in old age: 5-10 % of dementias, 17 % of mild cognitive impairment, and app. 20 % of benign age-influenced changes (Mauk, 2013). With the mean life expectancy rising, incidence of cognitive disorders will also be rising (Smith, Bondi, 2013). Despite this fact, 49 % of the general practitioners do not examine cognitive functions in elderly patients at all or only occasionally, other 18 % of them would perform this examination but they do not know how, and 12 % of them do not have time for this diagnostics. Standardised tests are known only to 8 % of the general practitioners and only half of them use it. Therefore, the alarming 60-70 % of geriatric patients with dementia in higher age are not usually diagnosed (Topinková, Jirák, Kožený, 2002). Cognitive examination performed by screening tests is a necessary part of cognitive disorders diagnostics. In appropriate usage, the screening tests of cognitive functions may reveal partial stage of cognitive deficit. The results of screening methods should be in compliance with the information about the patient’s problems which are communicated by conversation with the patient and persons in their proximate surrounding. However, complex neuropsychological examination is essential for thorough specification of cognitive deficiency. The same applies not only to mild cognitive impairment study but mainly for pre-clinic study of neurodegenerative diseases leading to cognitive deficit, when the first cognitive problems might occur, which are sensed subjectively by the patient (Tuokko, Hultsch, 2013). Cognitive disorders assessment in context of recognition need is a part of complex assessment of a geriatric patient and it is based on the data gained by various methods. It does not replace clinic examination and it is understood as a supplementary method to other methods of data collection (Barker, Board, 2012). The most widespread short screening test is the Test MMSE – Mini-Mental State Examination, which evaluates orientation, extent of attention, attention and calculation, memory and language (Folstein, Folstein, McHugh, 1975). Due to low sensitivity, however, it is rather inappropriate in mild cognitive impairment diagnostics and it is particularly applied in dementia syndrome diagnostics. Low sensitivity in patients with mild cognitive impairment is caused by relative simplicity of the test in relation to memory and low representation of items which test the memory, and also by absence of tasks for frontal functions such as planning, values. The MMSE sensitivity was good, and that was at the level = 0.83 with a confidence interval 95 % from 0.62 to 0.95. The MoCA sensitivity was very good, and that was at the level = 0.98 with 95 % of the confidence interval from 0.80 to 0.99. The MMSE specificity was very good, and that was at the level = 0.99 with 95 % of the confidence interval from 0.92 to 0.99. The MoCA specificity was good, and that was at the level = 0.85 with 95 % of the confidence interval from 0.73 to 0.91. We have demonstrated a good internal consistency for both of the methods, and that means these screening methods are stable at the time and they provide reliable measuring of cognitive deficit. 64 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 7 No. 2 2016 decision-making, attention and others. The second mostly used short screening test for cognitive functions evaluation is the MoCA – Montreal Cognitive Assessment (Nasreddine et al., 2005). Out of the cognitive skills, the MoCA is focused on visuospatial functions, naming, and memory including delayed recall, attention, language, abstraction and orientation. It means that it encompasses greater spectrum of tasks demanding of executive functions and in all it is more difficult test than the MMSE. Advantage of the MoCA is sensitivity rise of the test in patients with mild cognitive impairment without significant impact on specificity, and at the same time still relatively short period of administration. Patients and Methods Analysis of psychometric features of the MMSE and MoCA methods was performed on a sample of 84 geriatric patients. With regard to gender, the examined group was formed by 29 men (35 % of N = 84) and 55 women (65 % of N = 84). The mean age of the examined group was 77 (SD = 3.9) with the variation span of 12 years; the minimum age of 71 (N = 10) and maximum age of 83 years (N = 4). In the group of men the mean age was 76.5 (SD = 4.4) and in the group of women 77.2 (SD = 3.6). The selection criteria for geriatric patient classification into the examined group were: the age of 65 and more, willingness and ability to cooperate, the language kept, fine motor movement, sight and hearing. The data collection was taking place from July 2015 to February 2016. We found the concurrent validity by calculation of Pearson’s correlation coefficient between the test scores of the MMSE and MoCA methods. We have also performed reliability analysis of both screening methods by calculation of internal consistency of both screening methods. We determined the sensitivity and specificity based on dementia diagnosis in comparison with the critical cut off score of 26 points, and that was both for the MMSE methodology as well as the MoCA, so called gained test score of 25 and less represented cognitive deficit. Results and Discussion First, we analysed the concurrent, or also so called diagnostic, validity which is represented by Pearson’s correlation coefficient between the test scores of the MMSE and MoCA methods; r (84) = 0.77, P < 0.001. Based on the correlative analysis, we can state that the test score of the MMSE is in a very tight positive correlation with the test score of the MoCA which is graphically illustrated by the means of correlation diagram (Graph 1). In the graph, there are geriatric patients marked by red who had dementia diagnosis confirmed and there are geriatric patients without dementia diagnosis marked by blue. Also, we have performed reliability analysis of both screening methods. Internal consistency of the MMSE method was represented by Cronbach’s alpha at the level of 0.78 and the MoCA method at the level of 0.81. The optimum value of Cronbach’s alpha, which points to sufficient internal consistency of the method, is considered the value from 0.7 up to 0.9 (see e.g. Tavakol, Dennick, 2011). We determined the sensitivity and specificity based on dementia diagnosis in comparison with the critical cut off score = 26 points for both the MMSE method as well as the MoCA method, the so called gained test score of 25 points and less represents cognitive deficit or dementia. The MMSE sensitivity was good, and that was at the level = 0.83 with 95 % of the confidence interval from 0.62 to 0.95. The MoCA sensitivity was very good, and that was at the level = 0.98 with 95 % of the confidence interval from 0.80 to 0.99. The 65 Original Articles Clinical Social Work and Health Intervention Vol. 7 No. 2 2016 MMSE specificity was very good, and that was at the level = 0.99 with 95 % confidence interval from 0.92 to 0.99. The MoCA specificity was good, and that was at the level = 0.85 with 95 % of the confidence interval from 0.73 to 0.91. In accordance with the foreign studies (Amieva et al., 2014; Imtiaz et al., 2014; Trzepacz et al., 2015), we have demonstrated a good internal consistency for both methods, which means that these screening methods are stable at the time and they provide reliable measurements of cognitive deficit. Further on, the MoCA had a very good concurrent validity with the MMSE. This result has been expected because both Graph 1 Correlation diagram score of the MMSE with the MoCA Table 1 Contingency table for the MMSE and the MoCA cut off with dementia diagnosis 26 and more MMSE MoCA 25 and less 26 and more 25 and less Dementia diagnosis No 64 1 55 10 |
| Starting Page | 62 |
| Ending Page | 69 |
| Page Count | 8 |
| File Format | PDF HTM / HTML |
| DOI | 10.22359/cswhi_7_2_08 |
| Alternate Webpage(s) | http://www.clinicalsocialwork.eu/wp-content/uploads/2016/06/08-kabatova-putekova-martinkova.pdf |
| Alternate Webpage(s) | https://doi.org/10.22359/cswhi_7_2_08 |
| Volume Number | 7 |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
