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Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease.
Dement Geriatr Cogn Disord. 2019; 47(4-6):187-197.DG

Abstract

BACKGROUND

Clinical monitoring of patients with Parkinson's disease (PD) for cognitive decline is an important element of care. The Montreal Cognitive Assessment (MoCA) has been proposed to be a sensitive tool for assessing cognitive impairment in PD. The aim of our study was to compare the responsiveness of the MoCA to decline in cognition to the responsiveness of the Mini Mental State Examination (MMSE) and the Scales for Outcomes of Parkinson's disease-cognition (SCOPA-Cog).

METHODS

PD patients without dementia were enrolled at 6 North American movement disorders centers between 2008 and 2011. Participants received annual evaluations including the MoCA, MMSE, and SCOPA-Cog followed by formal neuropsychological testing. The gold standard for change in cognition was defined as the change on the neuropsychological test scores over the annual assessments. The Reliable Change Method was used to provide an estimate of the probability that a given difference score would be obtained by chance. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change was quantified using receiver operating characteristics (ROC) curves.

RESULTS

One hundred seventeen patients were included in the analysis. Participants were followed at mean intervals of 11 ± 2 months for a median of 2 (maximum 5) visits. According to the reliable change index, 56 intervals of cognitive testing showed a decline in global cognition. ROC analysis of change in MoCA, MMSE, and SCOPA-Cog global scores compared to gold standard testing found an area under the curve (AUC) of 0.55 (95% CI 0.48-0.62), 0.56 (0.48-0.63), and 0.63 (0.55-0.70) respectively. There were no significant differences in the AUCs across the tests. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change at various thresholds for decline in scores reached a maximum of 71% for a cut-off of 1 point change on the SCOPA-Cog.

CONCLUSION

Using neuropsychological testing as a gold standard comparator, the performance of the MoCA, MMSE, and SCOPA-Cog for detecting decline in non-demented PD patients over a 1-year interval is poor. This has implications for clinical practice; stable scores may not be taken as reassurance of the absence of cognitive decline.

Authors+Show Affiliations

The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, Ontario, Canada. Movement Disorders Unit, Tel Aviv Medical Center, Tel Aviv, Israel.The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, Ontario, Canada.Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada.Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, USA.The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, Ontario, Canada.Departments of Neurology, Neural and Behavioral Sciences, and Radiology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.Division of Biostatistics, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.Division of Neurology, University Health Network Memory Clinic, University of Toronto, Toronto, Ontario, Canada.The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, Ontario, Canada.Department of Neurology, Northwestern University, Chicago, Illinois, USA.Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, Illinois, USA.Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.Parkinson and Other Movement Disorders Center, Department of Neuroscience, UC San Diego, San Diego, California, USA.Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA.Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.Department of Psychiatry and Behavioural Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, Ontario, Canada.The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, Ontario, Canada, connie.marras@utoronto.ca.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

31315127

Citation

Faust-Socher, Achinoam, et al. "Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients With Parkinson's Disease." Dementia and Geriatric Cognitive Disorders, vol. 47, no. 4-6, 2019, pp. 187-197.
Faust-Socher A, Duff-Canning S, Grabovsky A, et al. Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease. Dement Geriatr Cogn Disord. 2019;47(4-6):187-197.
Faust-Socher, A., Duff-Canning, S., Grabovsky, A., Armstrong, M. J., Rothberg, B., Eslinger, P. J., Meaney, C. A., Schneider, R. B., Tang-Wai, D. F., Fox, S. H., Zadikoff, C., Kennedy, N., Chou, K. L., Persad, C., Litvan, I., Mast, B. T., Gerstenecker, A. T., Weintraub, S., Reginold, W., & Marras, C. (2019). Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease. Dementia and Geriatric Cognitive Disorders, 47(4-6), 187-197. https://doi.org/10.1159/000496454
Faust-Socher A, et al. Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients With Parkinson's Disease. Dement Geriatr Cogn Disord. 2019;47(4-6):187-197. PubMed PMID: 31315127.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease. AU - Faust-Socher,Achinoam, AU - Duff-Canning,Sarah, AU - Grabovsky,Arthur, AU - Armstrong,Melissa J, AU - Rothberg,Brandon, AU - Eslinger,Paul J, AU - Meaney,Christopher A, AU - Schneider,Ruth B, AU - Tang-Wai,David F, AU - Fox,Susan H, AU - Zadikoff,Cindy, AU - Kennedy,Nancy, AU - Chou,Kelvin L, AU - Persad,Carol, AU - Litvan,Irene, AU - Mast,Benjamin T, AU - Gerstenecker,Adam T, AU - Weintraub,Sandra, AU - Reginold,William, AU - Marras,Connie, Y1 - 2019/07/17/ PY - 2018/07/06/received PY - 2018/12/26/accepted PY - 2019/7/18/pubmed PY - 2020/1/23/medline PY - 2019/7/18/entrez KW - Cognitive decline KW - Mild cognitive impairment KW - Parkinson’s disease KW - Responsiveness SP - 187 EP - 197 JF - Dementia and geriatric cognitive disorders JO - Dement Geriatr Cogn Disord VL - 47 IS - 4-6 N2 - BACKGROUND: Clinical monitoring of patients with Parkinson's disease (PD) for cognitive decline is an important element of care. The Montreal Cognitive Assessment (MoCA) has been proposed to be a sensitive tool for assessing cognitive impairment in PD. The aim of our study was to compare the responsiveness of the MoCA to decline in cognition to the responsiveness of the Mini Mental State Examination (MMSE) and the Scales for Outcomes of Parkinson's disease-cognition (SCOPA-Cog). METHODS: PD patients without dementia were enrolled at 6 North American movement disorders centers between 2008 and 2011. Participants received annual evaluations including the MoCA, MMSE, and SCOPA-Cog followed by formal neuropsychological testing. The gold standard for change in cognition was defined as the change on the neuropsychological test scores over the annual assessments. The Reliable Change Method was used to provide an estimate of the probability that a given difference score would be obtained by chance. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change was quantified using receiver operating characteristics (ROC) curves. RESULTS: One hundred seventeen patients were included in the analysis. Participants were followed at mean intervals of 11 ± 2 months for a median of 2 (maximum 5) visits. According to the reliable change index, 56 intervals of cognitive testing showed a decline in global cognition. ROC analysis of change in MoCA, MMSE, and SCOPA-Cog global scores compared to gold standard testing found an area under the curve (AUC) of 0.55 (95% CI 0.48-0.62), 0.56 (0.48-0.63), and 0.63 (0.55-0.70) respectively. There were no significant differences in the AUCs across the tests. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change at various thresholds for decline in scores reached a maximum of 71% for a cut-off of 1 point change on the SCOPA-Cog. CONCLUSION: Using neuropsychological testing as a gold standard comparator, the performance of the MoCA, MMSE, and SCOPA-Cog for detecting decline in non-demented PD patients over a 1-year interval is poor. This has implications for clinical practice; stable scores may not be taken as reassurance of the absence of cognitive decline. SN - 1421-9824 UR - https://www.unboundmedicine.com/medline/citation/31315127/Responsiveness_to_Change_of_the_Montreal_Cognitive_Assessment_Mini_Mental_State_Examination_and_SCOPA_Cog_in_Non_Demented_Patients_with_Parkinson's_Disease_ L2 - https://www.karger.com?DOI=10.1159/000496454 DB - PRIME DP - Unbound Medicine ER -