Accuracy of the short-form Montreal Cognitive Assessment: Systematic review and validation

Jennifer A. McDicken, Emma Elliott, Gareth Blayney, Stephen Makin, Myzoon Ali, Andrew J Larner, Terence J. Quinn (Corresponding Author), VISTA-Cognition Collaborators

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: Short-form versions of the Montreal Cognitive Assessment (SF-MoCA) are increasingly used to screen for dementia in research and practice. We sought to collate evidence on the accuracy of SF-MoCAs and to externally validate these assessment tools. METHODS: We performed systematic literature searching across multidisciplinary electronic literature databases, collating information on the content and accuracy of all published SF-MoCAs. We then validated all the SF-MoCAs against clinical diagnosis using independent stroke (n = 787) and memory clinic (n = 410) data sets. RESULTS: We identified 13 different SF-MoCAs (21 studies, n = 6477 participants) with differing test content and properties. There was a pattern of high sensitivity across the range of SF-MoCA tests. In the published literature, for detection of post stroke cognitive impairment, median sensitivity across included studies: 0.88 (range: 0.70-1.00); specificity: 0.70 (0.39-0.92). In our independent validation using stroke data, median sensitivity: 0.99 (0.80-1.00); specificity: 0.40 (0.14-0.87). To detect dementia in older adults, median sensitivity: 0.88 (0.62-0.98); median specificity: 0.87 (0.07-0.98) in the literature and median sensitivity: 0.96 (range: 0.72-1.00); median specificity: 0.36 (0.14-0.86) in our validation. Horton's SF-MoCA (delayed recall, serial subtraction, and orientation) had the most favorable properties in stroke (sensitivity: 0.90, specificity: 0.87, positive predictive value [PPV]: 0.55, and negative predictive value [NPV]: 0.93), whereas Cecato's "MoCA reduced" (clock draw, animal naming, delayed recall, and orientation) performed better in the memory clinic (sensitivity: 0.72, specificity: 0.86, PPV: 0.55, and NPV: 0.93). CONCLUSIONS: There are many published SF-MoCAs. Clinicians and researchers using a SF-MoCA should be explicit about the content. For all SF-MoCA, sensitivity is high and similar to the full scale suggesting potential utility as an initial cognitive screening tool. However, choice of SF-MoCA should be informed by the clinical population to be studied.
Original languageEnglish
JournalThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
Early online date2 Jul 2019
DOIs
Publication statusE-pub ahead of print - 2 Jul 2019

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Stroke
Dementia
Sensitivity and Specificity
Research Personnel
Databases
Research
Population

Keywords

  • Montreal Cognitive Assessment
  • cognitive impairment
  • dementia
  • sensitivity
  • specificity
  • DIAGNOSTIC-TEST ACCURACY
  • DEMENTIA
  • SPECIFICITY
  • ASSESSMENT MOCA
  • PROTOCOL
  • SENSITIVITY
  • IMPAIRMENT
  • STROKE
  • SUBTESTS
  • UTILITY

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

Accuracy of the short-form Montreal Cognitive Assessment : Systematic review and validation. / McDicken, Jennifer A.; Elliott, Emma; Blayney, Gareth; Makin, Stephen; Ali, Myzoon; Larner, Andrew J; Quinn, Terence J. (Corresponding Author); Collaborators, VISTA-Cognition.

In: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 02.07.2019.

Research output: Contribution to journalArticle

McDicken, Jennifer A. ; Elliott, Emma ; Blayney, Gareth ; Makin, Stephen ; Ali, Myzoon ; Larner, Andrew J ; Quinn, Terence J. ; Collaborators, VISTA-Cognition. / Accuracy of the short-form Montreal Cognitive Assessment : Systematic review and validation. In: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry. 2019.
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T1 - Accuracy of the short-form Montreal Cognitive Assessment

T2 - Systematic review and validation

AU - McDicken, Jennifer A.

AU - Elliott, Emma

AU - Blayney, Gareth

AU - Makin, Stephen

AU - Ali, Myzoon

AU - Larner, Andrew J

AU - Quinn, Terence J.

AU - Collaborators, VISTA-Cognition

N1 - McDicken, Jennifer A Elliott, Emma Blayney, Gareth Makin, Stephen Ali, Myzoon Larner, Andrew J Quinn, Terence J eng England Int J Geriatr Psychiatry. 2019 Jun 26. doi: 10.1002/gps.5162.

PY - 2019/7/2

Y1 - 2019/7/2

N2 - INTRODUCTION: Short-form versions of the Montreal Cognitive Assessment (SF-MoCA) are increasingly used to screen for dementia in research and practice. We sought to collate evidence on the accuracy of SF-MoCAs and to externally validate these assessment tools. METHODS: We performed systematic literature searching across multidisciplinary electronic literature databases, collating information on the content and accuracy of all published SF-MoCAs. We then validated all the SF-MoCAs against clinical diagnosis using independent stroke (n = 787) and memory clinic (n = 410) data sets. RESULTS: We identified 13 different SF-MoCAs (21 studies, n = 6477 participants) with differing test content and properties. There was a pattern of high sensitivity across the range of SF-MoCA tests. In the published literature, for detection of post stroke cognitive impairment, median sensitivity across included studies: 0.88 (range: 0.70-1.00); specificity: 0.70 (0.39-0.92). In our independent validation using stroke data, median sensitivity: 0.99 (0.80-1.00); specificity: 0.40 (0.14-0.87). To detect dementia in older adults, median sensitivity: 0.88 (0.62-0.98); median specificity: 0.87 (0.07-0.98) in the literature and median sensitivity: 0.96 (range: 0.72-1.00); median specificity: 0.36 (0.14-0.86) in our validation. Horton's SF-MoCA (delayed recall, serial subtraction, and orientation) had the most favorable properties in stroke (sensitivity: 0.90, specificity: 0.87, positive predictive value [PPV]: 0.55, and negative predictive value [NPV]: 0.93), whereas Cecato's "MoCA reduced" (clock draw, animal naming, delayed recall, and orientation) performed better in the memory clinic (sensitivity: 0.72, specificity: 0.86, PPV: 0.55, and NPV: 0.93). CONCLUSIONS: There are many published SF-MoCAs. Clinicians and researchers using a SF-MoCA should be explicit about the content. For all SF-MoCA, sensitivity is high and similar to the full scale suggesting potential utility as an initial cognitive screening tool. However, choice of SF-MoCA should be informed by the clinical population to be studied.

AB - INTRODUCTION: Short-form versions of the Montreal Cognitive Assessment (SF-MoCA) are increasingly used to screen for dementia in research and practice. We sought to collate evidence on the accuracy of SF-MoCAs and to externally validate these assessment tools. METHODS: We performed systematic literature searching across multidisciplinary electronic literature databases, collating information on the content and accuracy of all published SF-MoCAs. We then validated all the SF-MoCAs against clinical diagnosis using independent stroke (n = 787) and memory clinic (n = 410) data sets. RESULTS: We identified 13 different SF-MoCAs (21 studies, n = 6477 participants) with differing test content and properties. There was a pattern of high sensitivity across the range of SF-MoCA tests. In the published literature, for detection of post stroke cognitive impairment, median sensitivity across included studies: 0.88 (range: 0.70-1.00); specificity: 0.70 (0.39-0.92). In our independent validation using stroke data, median sensitivity: 0.99 (0.80-1.00); specificity: 0.40 (0.14-0.87). To detect dementia in older adults, median sensitivity: 0.88 (0.62-0.98); median specificity: 0.87 (0.07-0.98) in the literature and median sensitivity: 0.96 (range: 0.72-1.00); median specificity: 0.36 (0.14-0.86) in our validation. Horton's SF-MoCA (delayed recall, serial subtraction, and orientation) had the most favorable properties in stroke (sensitivity: 0.90, specificity: 0.87, positive predictive value [PPV]: 0.55, and negative predictive value [NPV]: 0.93), whereas Cecato's "MoCA reduced" (clock draw, animal naming, delayed recall, and orientation) performed better in the memory clinic (sensitivity: 0.72, specificity: 0.86, PPV: 0.55, and NPV: 0.93). CONCLUSIONS: There are many published SF-MoCAs. Clinicians and researchers using a SF-MoCA should be explicit about the content. For all SF-MoCA, sensitivity is high and similar to the full scale suggesting potential utility as an initial cognitive screening tool. However, choice of SF-MoCA should be informed by the clinical population to be studied.

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KW - cognitive impairment

KW - dementia

KW - sensitivity

KW - specificity

KW - DIAGNOSTIC-TEST ACCURACY

KW - DEMENTIA

KW - SPECIFICITY

KW - ASSESSMENT MOCA

KW - PROTOCOL

KW - SENSITIVITY

KW - IMPAIRMENT

KW - STROKE

KW - SUBTESTS

KW - UTILITY

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