Moreover, information regarding single items can further help practitioners interpret test scores by qualitatively assigning different weights to different items. A widespread approach that allows a flexible use of cognitive screening tests is to provide norms for their domain-specific sub-tests. Psychometric investigations on the MoCA have been carried out both at the sub-test and the single-item levels. In Italy, the MoCA has been adapted and standardized-and both its statistical properties and clinical usability thoroughly examined. The MoCA is a rapid (5–10’) screening test which evaluates both non-instrumental (executive functioning, attention) and instrumental (language, memory, visuo-spatial abilities, orientation) domains. The Montreal Cognitive Assessment (MoCA) is one of the most widespread and psychometrically robust screening tools for cognitive impairments of graded severity. Fine-grained, adaptive psychometric approaches can thus help solve interpretation issues to facilitate diagnostic processes by magnifying informativity. Compared to screening tests for dementia, those aimed at detecting mild-to-moderate cognitive impairment may be harder for practitioners to interpret because of (a) the magnitude of the target construct (i.e., the deficit) being less obvious and (b) the amount of information provided by the test being limited. None of the studies evaluating MoCA in this review were performed in a primary care setting, which would limit the use of this test in a typical screening population.Cognitive screening/first-level tests allow an estimate of global efficiency/functioning by adequately balancing between informativity and practicality of usage. 7 Of the four studies using a score of less than 26 on the MoCA, there was at least a 94% sensitivity in detecting patients with dementia however, specificity for these diagnoses was poor (60% and lower). As noted by the developers of the MoCA, although a score of 18 may be considered the cutoff for Alzheimer disease, a standard cutoff score for dementia has not been established. Four studies used the standard threshold for mild cognitive impairment (a score of less than 26), and three studies used lower scores. Significant heterogeneity among the seven studies made direct comparison of the findings difficult. A single study in China accounted for 8,411 patients and had a baseline prevalence of dementia of 5%. 3 The authors included seven studies of 9,422 patients from multiple developed countries (the prevalence of dementia ranged from 5% to 54%). The authors of the study reported a negative predictive value of greater than 90% at all studied thresholds (reported as 3.2 to 3.7 on a scale of 1 to 5) but a positive predictive value of less than 50% for cutoff points below 3.6, indicating limited clinical utility of a positive result and the potential for large numbers of patients who do not have dementia to be referred for specialist evaluation.Ī third Cochrane review sought to determine the accuracy of the Montreal Cognitive Assessment (MoCA) for the detection of dementia. The study was at high risk of bias in multiple areas, including patient selection, unclear processes for test administration and results reporting, and use of a reference standard for clinical diagnosis of dementia that the reviewers did not consider standard practice. The prevalence of dementia in this cohort was 16 cases among 230 participants (7%). The Cochrane review identified only one study that took place at a primary care clinic site in Hawaii and included 230 participants of self-identified Japanese-American descent. 2 This questionnaire asks an acquaintance to judge on a scale of 1 to 5 how the patient's memory has changed over the course of 10 years in a variety of parameters (1 = much improved, 2 = a bit improved, 3 = unchanged, 4 = a bit worse, and 5 = much worse). A second Cochrane review examined the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), available as a 16- or 26-item test for cognitive impairment.
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