Journal Article

Enhanced diagnostic accuracy for neurocognitive disorders: a revised cut-off approach for the Montreal Cognitive Assessment

Goettel, Nicolai, Thomann, Alessandra E., Berres, Manfred, Steiner, Luzius A., Monsch, Andreas U.

2020

Overview

Background The Montreal Cognitive Assessment (MoCA) has good sensitivity for mild cognitive impairment, but specificity is low when the original cut-off (25/26) is used. We aim to revise the cut-off on the German MoCA for its use in clinical routine. Methods Data were analyzed from 496 Memory Clinic outpatients (447 individuals with a neurocognitive disorder; 49 with cognitive normal findings) and from 283 normal controls. Cut-offs were identified based on (a) Youden’s index and (b) the 10th percentile of the control group. Results A cut-off of 23/24 on the MoCA had better correct classification rates than the MMSE and the original MoCA cut-off. Compared to the original MoCA cut-off, the cut-off of 23/24 points had higher specificity (92% vs 63%), but lower sensitivity (65% vs 86%). Introducing two separate cut-offs increased diagnostic accuracies with 92% specificity (23/24 points) and 91% sensitivity (26/27 points). Scores between these two cut-offs require further examinations. Conclusions Using two separate cut-offs for the MoCA combined with scores in an indecisive area enhances the accuracy of cognitive screening.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Accuracy / Age / Alzheimer's disease / Biomedical and Life Sciences / Biomedicine / Cognitive ability / Cognitive disorders / Comparative analysis / Dementia / Demography / Education / Geriatric Psychiatry / Geriatrics / Geriatrics/Gerontology / Medical diagnosis / Medical research / Memory / Mental depression / Mental status and dementia tests / Mild cognitive impairment / Mini Mental State Examination / Montreal Cognitive Assessment / Neurocognitive disorders / Neurology / Neuropsychology / Neurosciences / Patients / Sensitivity and specificity