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Diagnostic utility of Montreal Cognitive Assessment in the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders: major and mild neurocognitive disorders.
J Am Med Dir Assoc. 2015 Feb; 16(2):144-8.JA

Abstract

OBJECTIVES

The Montreal Cognitive Assessment (MOCA) is a screening tool for mild cognitive impairment (MCI) and dementia. The new criteria for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) mild neurocognitive disorder (NCD) define participants with cognitive decline but no dementia, and major NCD (dementia). We explored the usefulness of MOCA to detect major and mild NCD.

DESIGN

Cross-sectional test research.

SETTING

Tertiary hospital memory clinic and community-based Singapore Longitudinal Aging Study (SLAS).

PARTICIPANTS

Participants with questionable dementia (clinical dementia rating, CDR = 0.5) and early dementia (CDR ≤1) over a period of 1 year were identified from the memory clinic registry. The patient records were reviewed and the diagnostic labels of major and mild NCD were applied accordingly. Healthy controls (HC) (CDR = 0, Mini-Mental State Examination >26) were recruited from the on-going SLAS.

MEASUREMENTS

Major and mild NCD were diagnosed based on medical history, clinical examination, basic and instrumental activities of daily living, locally validated bedside cognitive tests (Mini-Mental State Examination, Frontal Assessment Battery, and Clock Drawing Test), relevant laboratory investigations and standardized neuropsychological assessment.

RESULTS

Two hundred fifty-one participants were included (41 mild NCD, 64 major NCD, 146 HC). On receiver operating characteristic curve analysis, the diagnostic performance by area under the curve (AUC) for MOCA was 0.99 [95% confidence interval (CI) 0.98-1.0] for major NCD and 0.77 (95% CI 0.67-0.86) for mild NCD. For diagnosis of mild NCD, MOCA performed better in those with lower education (primary and below) (AUC 0.90) compared with those with secondary education and beyond (AUC 0.66).

CONCLUSION

MOCA has high diagnostic utility for major NCD but its usefulness in detecting mild NCD is more modest. Possible reasons include greater heterogeneity in participants with mild NCD and how "quantified clinical assessment" in the DSM-5 mild NCD criteria is interpreted and operationalized.

Authors+Show Affiliations

Department of Geriatric Psychiatry, Institute of Mental Health, Singapore. Electronic address: tau_ming_liew@imh.com.sg.Gerontology Research Program, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Gerontology Research Program, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Gerontology Research Program, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25282632

Citation

Liew, Tau Ming, et al. "Diagnostic Utility of Montreal Cognitive Assessment in the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders: Major and Mild Neurocognitive Disorders." Journal of the American Medical Directors Association, vol. 16, no. 2, 2015, pp. 144-8.
Liew TM, Feng L, Gao Q, et al. Diagnostic utility of Montreal Cognitive Assessment in the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders: major and mild neurocognitive disorders. J Am Med Dir Assoc. 2015;16(2):144-8.
Liew, T. M., Feng, L., Gao, Q., Ng, T. P., & Yap, P. (2015). Diagnostic utility of Montreal Cognitive Assessment in the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders: major and mild neurocognitive disorders. Journal of the American Medical Directors Association, 16(2), 144-8. https://doi.org/10.1016/j.jamda.2014.07.021
Liew TM, et al. Diagnostic Utility of Montreal Cognitive Assessment in the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders: Major and Mild Neurocognitive Disorders. J Am Med Dir Assoc. 2015;16(2):144-8. PubMed PMID: 25282632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic utility of Montreal Cognitive Assessment in the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders: major and mild neurocognitive disorders. AU - Liew,Tau Ming, AU - Feng,Lei, AU - Gao,Qi, AU - Ng,Tze Pin, AU - Yap,Philip, Y1 - 2014/10/03/ PY - 2014/06/12/received PY - 2014/07/29/revised PY - 2014/07/29/accepted PY - 2014/10/6/entrez PY - 2014/10/6/pubmed PY - 2015/11/18/medline KW - DSM-5 KW - Montreal Cognitive Assessment KW - diagnostic performance KW - neurocognitive disorder KW - quantified clinical assessment SP - 144 EP - 8 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 16 IS - 2 N2 - OBJECTIVES: The Montreal Cognitive Assessment (MOCA) is a screening tool for mild cognitive impairment (MCI) and dementia. The new criteria for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) mild neurocognitive disorder (NCD) define participants with cognitive decline but no dementia, and major NCD (dementia). We explored the usefulness of MOCA to detect major and mild NCD. DESIGN: Cross-sectional test research. SETTING: Tertiary hospital memory clinic and community-based Singapore Longitudinal Aging Study (SLAS). PARTICIPANTS: Participants with questionable dementia (clinical dementia rating, CDR = 0.5) and early dementia (CDR ≤1) over a period of 1 year were identified from the memory clinic registry. The patient records were reviewed and the diagnostic labels of major and mild NCD were applied accordingly. Healthy controls (HC) (CDR = 0, Mini-Mental State Examination >26) were recruited from the on-going SLAS. MEASUREMENTS: Major and mild NCD were diagnosed based on medical history, clinical examination, basic and instrumental activities of daily living, locally validated bedside cognitive tests (Mini-Mental State Examination, Frontal Assessment Battery, and Clock Drawing Test), relevant laboratory investigations and standardized neuropsychological assessment. RESULTS: Two hundred fifty-one participants were included (41 mild NCD, 64 major NCD, 146 HC). On receiver operating characteristic curve analysis, the diagnostic performance by area under the curve (AUC) for MOCA was 0.99 [95% confidence interval (CI) 0.98-1.0] for major NCD and 0.77 (95% CI 0.67-0.86) for mild NCD. For diagnosis of mild NCD, MOCA performed better in those with lower education (primary and below) (AUC 0.90) compared with those with secondary education and beyond (AUC 0.66). CONCLUSION: MOCA has high diagnostic utility for major NCD but its usefulness in detecting mild NCD is more modest. Possible reasons include greater heterogeneity in participants with mild NCD and how "quantified clinical assessment" in the DSM-5 mild NCD criteria is interpreted and operationalized. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/25282632/Diagnostic_utility_of_Montreal_Cognitive_Assessment_in_the_Fifth_Edition_of_Diagnostic_and_Statistical_Manual_of_Mental_Disorders:_major_and_mild_neurocognitive_disorders_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(14)00480-0 DB - PRIME DP - Unbound Medicine ER -