The Montreal Cognitive Assessment (MoCA) with a double threshold: improving the MoCA for triaging patients in need of a neuropsychological assessment
Diagnosis of patients suspected of mild dementia (MD) is a challenge and patient numbers continue to rise. A short test triaging patients in need of a neuropsychological assessment (NPA) is welcome. The Montreal cognitive assessment (MoCA) has high sensitivity at the original cutoff
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| Veröffentlicht in: | International psychogeriatrics 2022-06, Vol.34 (6), p.571-583 |
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| creator | Dautzenberg, Géraud M.F.C. Lijmer, Jeroen G. Beekman, Aartjan T.F. |
| description | Diagnosis of patients suspected of mild dementia (MD) is a challenge and patient numbers continue to rise. A short test triaging patients in need of a neuropsychological assessment (NPA) is welcome. The Montreal cognitive assessment (MoCA) has high sensitivity at the original cutoff |
| doi_str_mv | 10.1017/S1041610221000612 |
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In this study, we compared different selection strategies to efficiently identify patients in need of an NPA. Using the MoCA with a double threshold tackles the dilemma of increasing the specificity without decreasing the sensitivity and creates the opportunity to distinguish the clinical (MD) and subclinical (MCI) state and hence to get their appropriate policy.
Patients referred to old-age psychiatry suspected of cognitive impairment that could benefit from an NPA (n = 693).
The optimal strategy was a two-stage selection process using the MoCA with a double threshold as an add-on after initial assessment. By selecting who is likely to have dementia and should be assessed further (MoCA<21), who should be discharged (≥26), and who’s course should be monitored actively as they are at increased risk (21<26).
By using two cutoffs, the clinical value of the MoCA improved for triaging. A double-threshold MoCA not only gave the best results; accuracy, PPV, NPV, and reducing FP referrals by 65%, still correctly triaging most MD patients. It also identified most MCIs whose intermediate state justifies active monitoring.</description><identifier>ISSN: 1041-6102</identifier><identifier>EISSN: 1741-203X</identifier><identifier>DOI: 10.1017/S1041610221000612</identifier><language>eng</language><publisher>Cambridge: Elsevier Inc</publisher><subject>Age ; Alzheimer's disease ; Clinical medicine ; Cognitive ability ; Cognitive impairment ; Dementia ; double threshold ; Drug abuse ; False positive results ; High risk ; intermediate state ; Medical diagnosis ; Medical referrals ; Memory ; memory clinic ; Mental disorders ; MoCA ; Neuropsychological assessment ; Neuropsychology ; old-age psychiatry ; Psychiatry ; Psychotropic drugs ; subthreshold disorders ; triaging</subject><ispartof>International psychogeriatrics, 2022-06, Vol.34 (6), p.571-583</ispartof><rights>2021 International Psychogeriatric Association 2021</rights><rights>International Psychogeriatric Association 2021. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the associated terms available at: https://uk.sagepub.com/en-gb/eur/reusing-open-access-and-sage-choice-content</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c401t-ee5ae0178c468b772a52651a23ad7201cf064d20f455c62c8a8a48e8ca73c8b23</citedby><cites>FETCH-LOGICAL-c401t-ee5ae0178c468b772a52651a23ad7201cf064d20f455c62c8a8a48e8ca73c8b23</cites><orcidid>0000-0001-8943-200X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,12825,27901,27902,30976</link.rule.ids></links><search><creatorcontrib>Dautzenberg, Géraud M.F.C.</creatorcontrib><creatorcontrib>Lijmer, Jeroen G.</creatorcontrib><creatorcontrib>Beekman, Aartjan T.F.</creatorcontrib><title>The Montreal Cognitive Assessment (MoCA) with a double threshold: improving the MoCA for triaging patients in need of a neuropsychological assessment</title><title>International psychogeriatrics</title><description>Diagnosis of patients suspected of mild dementia (MD) is a challenge and patient numbers continue to rise. A short test triaging patients in need of a neuropsychological assessment (NPA) is welcome. The Montreal cognitive assessment (MoCA) has high sensitivity at the original cutoff <26 for MD, but results in too many false-positive (FP) referrals in clinical practice (low specificity). A cutoff that finds all patients at high risk of MD without referring to many patients not (yet) in need of an NPA is needed. A difficulty is who is to be considered at risk, as definitions for disease (e.g. MD) do not always define health at the same time and thereby create subthreshold disorders.
In this study, we compared different selection strategies to efficiently identify patients in need of an NPA. Using the MoCA with a double threshold tackles the dilemma of increasing the specificity without decreasing the sensitivity and creates the opportunity to distinguish the clinical (MD) and subclinical (MCI) state and hence to get their appropriate policy.
Patients referred to old-age psychiatry suspected of cognitive impairment that could benefit from an NPA (n = 693).
The optimal strategy was a two-stage selection process using the MoCA with a double threshold as an add-on after initial assessment. By selecting who is likely to have dementia and should be assessed further (MoCA<21), who should be discharged (≥26), and who’s course should be monitored actively as they are at increased risk (21<26).
By using two cutoffs, the clinical value of the MoCA improved for triaging. A double-threshold MoCA not only gave the best results; accuracy, PPV, NPV, and reducing FP referrals by 65%, still correctly triaging most MD patients. It also identified most MCIs whose intermediate state justifies active monitoring.</description><subject>Age</subject><subject>Alzheimer's disease</subject><subject>Clinical medicine</subject><subject>Cognitive ability</subject><subject>Cognitive impairment</subject><subject>Dementia</subject><subject>double threshold</subject><subject>Drug abuse</subject><subject>False positive results</subject><subject>High risk</subject><subject>intermediate state</subject><subject>Medical diagnosis</subject><subject>Medical referrals</subject><subject>Memory</subject><subject>memory clinic</subject><subject>Mental disorders</subject><subject>MoCA</subject><subject>Neuropsychological assessment</subject><subject>Neuropsychology</subject><subject>old-age psychiatry</subject><subject>Psychiatry</subject><subject>Psychotropic drugs</subject><subject>subthreshold disorders</subject><subject>triaging</subject><issn>1041-6102</issn><issn>1741-203X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kcFO3DAQhqMKpC7QB-jNUi9wCPU4dmLKaRW1pdIiDoDUm-V1JrtGWXtrO4v2QXjfOlrUQ5E42Zr5_2_8e4riM9BLoNB8vQfKoQbKGFBKa2Afihk0HEpGq99H-Z7b5dT_WJzE-EQpExXwWfHysEZy610KqAfS-pWzye6QzGPEGDfoEjm_9e38gjzbtCaadH5cDkjSOmBc-6H7RuxmG_zOulUuTqx2TnofSApWr6bqViebOZFYRxxiR3yfOQ7H4LdxbzLEr6zJ0_W_mWfFca-HiJ9ez9Pi8cf3h_amXNz9_NXOF6XhFFKJKDTm9NLwWi6bhmnBagGaVbprGAXT05p3jPZcCFMzI7XUXKI0uqmMXLLqtDg_cHOCPyPGpDY2GhwG7dCPUTFRN1eSCVll6Zf_pE9-DC6_TrFaCsarBkRWwUFlgo8xYK-2wW502CugalqUerOo7Lk-eDAn3VkMKpr8YQY7G9Ak1Xn7jvsvHb2Y0g</recordid><startdate>20220601</startdate><enddate>20220601</enddate><creator>Dautzenberg, Géraud M.F.C.</creator><creator>Lijmer, Jeroen G.</creator><creator>Beekman, Aartjan T.F.</creator><general>Elsevier Inc</general><general>Cambridge University Press</general><scope>6I.</scope><scope>AAFTH</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7QJ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88J</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HEHIP</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2R</scope><scope>M2S</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8943-200X</orcidid></search><sort><creationdate>20220601</creationdate><title>The Montreal Cognitive Assessment (MoCA) with a double threshold: improving the MoCA for triaging patients in need of a neuropsychological assessment</title><author>Dautzenberg, Géraud M.F.C. ; 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A short test triaging patients in need of a neuropsychological assessment (NPA) is welcome. The Montreal cognitive assessment (MoCA) has high sensitivity at the original cutoff <26 for MD, but results in too many false-positive (FP) referrals in clinical practice (low specificity). A cutoff that finds all patients at high risk of MD without referring to many patients not (yet) in need of an NPA is needed. A difficulty is who is to be considered at risk, as definitions for disease (e.g. MD) do not always define health at the same time and thereby create subthreshold disorders.
In this study, we compared different selection strategies to efficiently identify patients in need of an NPA. Using the MoCA with a double threshold tackles the dilemma of increasing the specificity without decreasing the sensitivity and creates the opportunity to distinguish the clinical (MD) and subclinical (MCI) state and hence to get their appropriate policy.
Patients referred to old-age psychiatry suspected of cognitive impairment that could benefit from an NPA (n = 693).
The optimal strategy was a two-stage selection process using the MoCA with a double threshold as an add-on after initial assessment. By selecting who is likely to have dementia and should be assessed further (MoCA<21), who should be discharged (≥26), and who’s course should be monitored actively as they are at increased risk (21<26).
By using two cutoffs, the clinical value of the MoCA improved for triaging. A double-threshold MoCA not only gave the best results; accuracy, PPV, NPV, and reducing FP referrals by 65%, still correctly triaging most MD patients. It also identified most MCIs whose intermediate state justifies active monitoring.</abstract><cop>Cambridge</cop><pub>Elsevier Inc</pub><doi>10.1017/S1041610221000612</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-8943-200X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); Cambridge University Press Journals Complete |
| subjects | Age Alzheimer's disease Clinical medicine Cognitive ability Cognitive impairment Dementia double threshold Drug abuse False positive results High risk intermediate state Medical diagnosis Medical referrals Memory memory clinic Mental disorders MoCA Neuropsychological assessment Neuropsychology old-age psychiatry Psychiatry Psychotropic drugs subthreshold disorders triaging |
| title | The Montreal Cognitive Assessment (MoCA) with a double threshold: improving the MoCA for triaging patients in need of a neuropsychological assessment |
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