![]() ![]() 17 Dementia patients associated with executive dysfunction scored higher on MMSE relative to MoCA than dementia patients where executive function is less affected. The different focus of the tests can be seen in a large multicentre study. 16 However, reduced verbal abilities are seldom the first sign of cognitive decline, so a focus on language-related abilities is not suitable for the detection of early symptoms of dementia or mild cognitive impairments (MCI). The MMSE assesses verbal abilities, which are often affected in advanced AD and other forms of dementia, such as Dementia with Lewy Bodies (DLB) 15 and Parkinson’s disease (PD). The MMSE and MoCA tests overlap but weigh the cognitive domains differently. However, these studies also find that the MMSE has acceptable sensitivity to identify dementia. 11 concluded that 80% of the included 34 articles found that the MoCA test was superior to the MMSE test in discriminating between individuals with mild cognitive impairment and no cognitive impairment, while they concluded that both tests were accurate in the detection of Alzheimer’s disease (AD). 2Ī meta-analysis of 34 English language dementia studies 14 using cut-off scores ranging from 27/30 to 22/30 concluded that the MMSE was only “modestly effective at ruling-out dementia in specialist settings.” In a recent meta-study, Pinto et al. The established cut-off point for ruling out a cognitive decline in elderly patients from normal controls is 26 points. 11 These results include one point added for patients with less than 12 years of education since education level greatly affects performance. 12 For the MoCA test, the cut-off points for the elderly vary greatly, from a 23–25-point range depending on ethnicity in an American study 6 to 20–21 points in a Brazilian study. 13 Cut-offs that are as low as 20 points have been suggested for low-educated elderly. 2, 9, 12, 13 The MMSE cut-off score most commonly used for determining cognitive deficits in patients aged 65 years and above is 24 points. Both the MMSE and the MoCA tests have a score range from 0 to 30 points. Several studies on elderly patients have pointed out that the established cut-off scores for MMSE and MoCA may be too rigorous. 6, 10, 11 There is no consensus on the appropriate cut-off score in an elderly psychiatric environment, although both MoCA and MMSE are well established. The cut-offs used vary greatly between patient studies and are specific to the patient groups being studied 7 – 9 and the language version used or ethnicity of the patients. To screen incoming patients, the ability to identify the presence of dementia (sensitivity) is more important than the ability to identify the absence of dementia (specificity), but for a cost-efficient assessment, a trade-off where both sensitivity and specificity are near their peaks is preferred as a cut-off to identify possible dementia patients from the patient pool. Education level, gender, and ethnicity are other moderating factors in cognitive tests. In this complicated environment, screening for dementia disease becomes challenging. Each of these factors, or a combination of them, may lead to permanent or temporary cognitive decline. 4 Disease comorbidity in addition to increased age may influence MMSE and MoCA scores to varying degrees, and since the cognitive decline is a natural part of aging, the effects of age become more influential on test scores over time. Also, patients with dementia often have comorbid diagnoses, such as depression, which may or may not be secondary to dementia. ![]() Depression and anxiety are prevalent and have a high rate of comorbidity, 3 while other common patient groups include schizophrenia and dementia. The population referred to an inpatient psychiatric clinic for the elderly are generally older than 65 years of age and include a diverse patient population and several diagnostic groups. Low scores on MoCA and MMSE do not necessarily indicate cognitive decline as individuals with chronically lower cognitive abilities, for example, intellectual developmental disorder, may naturally have a low score. One or both tests are typically included in the screening battery for incoming patients in psychiatric clinics for the elderly, used to direct further cognitive assessment. The Mini-Mental State Examination (MMSE) 1 and the Montreal Cognitive Assessment (MoCA) 2 are two commonly used screening tests for cognitive deficits. Since there are several cognitive functional areas, screening tests need to cover all cognitive areas and be sensitive enough to indicate cognitive decline even though only a single cognitive area has been affected. Screening tests are useful in detecting suspected cognitive decline. ![]()
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