Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease

Achinoam Faust-Socher, Sarah Duff-Canning, Arthur Grabovsky, Melissa J. Armstrong, Brandon Rothberg, Paul Eslinger, Christopher A. Meaney, Ruth B. Schneider, David F. Tang-Wai, Susan H. Fox, Cindy Zadikoff, Nancy Kennedy, Kelvin L. Chou, Carol Persad, Irene Litvan, Benjamin T. Mast, Adam T. Gerstenecker, Sandra Weintraub, William Reginold, Connie Marras

Research output: Contribution to journalArticle

Abstract

Background: Clinical monitoring of patients with Parkinson's disease (PD) for cognitive decline is an important element of care. The Montreal Cognitive Assessment (MoCA) has been proposed to be a sensitive tool for assessing cognitive impairment in PD. The aim of our study was to compare the responsiveness of the MoCA to decline in cognition to the responsiveness of the Mini Mental State Examination (MMSE) and the Scales for Outcomes of Parkinson's disease-cognition (SCOPA-Cog). Methods: PD patients without dementia were enrolled at 6 North American movement disorders centers between 2008 and 2011. Participants received annual evaluations including the MoCA, MMSE, and SCOPA-Cog followed by formal neuropsychological testing. The gold standard for change in cognition was defined as the change on the neuropsychological test scores over the annual assessments. The Reliable Change Method was used to provide an estimate of the probability that a given difference score would be obtained by chance. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change was quantified using receiver operating characteristics (ROC) curves. Results: One hundred seventeen patients were included in the analysis. Participants were followed at mean intervals of 11 ± 2 months for a median of 2 (maximum 5) visits. According to the reliable change index, 56 intervals of cognitive testing showed a decline in global cognition. ROC analysis of change in MoCA, MMSE, and SCOPA-Cog global scores compared to gold standard testing found an area under the curve (AUC) of 0.55 (95% CI 0.48-0.62), 0.56 (0.48-0.63), and 0.63 (0.55-0.70) respectively. There were no significant differences in the AUCs across the tests. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change at various thresholds for decline in scores reached a maximum of 71% for a cut-off of 1 point change on the SCOPA-Cog. Conclusion: Using neuropsychological testing as a gold standard comparator, the performance of the MoCA, MMSE, and SCOPA-Cog for detecting decline in non-demented PD patients over a 1-year interval is poor. This has implications for clinical practice; stable scores may not be taken as reassurance of the absence of cognitive decline.

Original languageEnglish (US)
Pages (from-to)187-197
Number of pages11
JournalDementia and Geriatric Cognitive Disorders
Volume47
Issue number4-6
DOIs
StatePublished - Oct 1 2019

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Cognition
Parkinson Disease
ROC Curve
Area Under Curve
Neuropsychological Tests
Movement Disorders
Physiologic Monitoring
Dementia

All Science Journal Classification (ASJC) codes

  • Geriatrics and Gerontology
  • Cognitive Neuroscience
  • Psychiatry and Mental health

Cite this

Faust-Socher, Achinoam ; Duff-Canning, Sarah ; Grabovsky, Arthur ; Armstrong, Melissa J. ; Rothberg, Brandon ; Eslinger, Paul ; Meaney, Christopher A. ; Schneider, Ruth B. ; Tang-Wai, David F. ; Fox, Susan H. ; Zadikoff, Cindy ; Kennedy, Nancy ; Chou, Kelvin L. ; Persad, Carol ; Litvan, Irene ; Mast, Benjamin T. ; Gerstenecker, Adam T. ; Weintraub, Sandra ; Reginold, William ; Marras, Connie. / Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease. In: Dementia and Geriatric Cognitive Disorders. 2019 ; Vol. 47, No. 4-6. pp. 187-197.
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title = "Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease",
abstract = "Background: Clinical monitoring of patients with Parkinson's disease (PD) for cognitive decline is an important element of care. The Montreal Cognitive Assessment (MoCA) has been proposed to be a sensitive tool for assessing cognitive impairment in PD. The aim of our study was to compare the responsiveness of the MoCA to decline in cognition to the responsiveness of the Mini Mental State Examination (MMSE) and the Scales for Outcomes of Parkinson's disease-cognition (SCOPA-Cog). Methods: PD patients without dementia were enrolled at 6 North American movement disorders centers between 2008 and 2011. Participants received annual evaluations including the MoCA, MMSE, and SCOPA-Cog followed by formal neuropsychological testing. The gold standard for change in cognition was defined as the change on the neuropsychological test scores over the annual assessments. The Reliable Change Method was used to provide an estimate of the probability that a given difference score would be obtained by chance. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change was quantified using receiver operating characteristics (ROC) curves. Results: One hundred seventeen patients were included in the analysis. Participants were followed at mean intervals of 11 ± 2 months for a median of 2 (maximum 5) visits. According to the reliable change index, 56 intervals of cognitive testing showed a decline in global cognition. ROC analysis of change in MoCA, MMSE, and SCOPA-Cog global scores compared to gold standard testing found an area under the curve (AUC) of 0.55 (95{\%} CI 0.48-0.62), 0.56 (0.48-0.63), and 0.63 (0.55-0.70) respectively. There were no significant differences in the AUCs across the tests. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change at various thresholds for decline in scores reached a maximum of 71{\%} for a cut-off of 1 point change on the SCOPA-Cog. Conclusion: Using neuropsychological testing as a gold standard comparator, the performance of the MoCA, MMSE, and SCOPA-Cog for detecting decline in non-demented PD patients over a 1-year interval is poor. This has implications for clinical practice; stable scores may not be taken as reassurance of the absence of cognitive decline.",
author = "Achinoam Faust-Socher and Sarah Duff-Canning and Arthur Grabovsky and Armstrong, {Melissa J.} and Brandon Rothberg and Paul Eslinger and Meaney, {Christopher A.} and Schneider, {Ruth B.} and Tang-Wai, {David F.} and Fox, {Susan H.} and Cindy Zadikoff and Nancy Kennedy and Chou, {Kelvin L.} and Carol Persad and Irene Litvan and Mast, {Benjamin T.} and Gerstenecker, {Adam T.} and Sandra Weintraub and William Reginold and Connie Marras",
year = "2019",
month = "10",
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doi = "10.1159/000496454",
language = "English (US)",
volume = "47",
pages = "187--197",
journal = "Dementia and Geriatric Cognitive Disorders",
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Faust-Socher, A, Duff-Canning, S, Grabovsky, A, Armstrong, MJ, Rothberg, B, Eslinger, P, Meaney, CA, Schneider, RB, Tang-Wai, DF, Fox, SH, Zadikoff, C, Kennedy, N, Chou, KL, Persad, C, Litvan, I, Mast, BT, Gerstenecker, AT, Weintraub, S, Reginold, W & Marras, C 2019, 'Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease', Dementia and Geriatric Cognitive Disorders, vol. 47, no. 4-6, pp. 187-197. https://doi.org/10.1159/000496454

Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease. / Faust-Socher, Achinoam; Duff-Canning, Sarah; Grabovsky, Arthur; Armstrong, Melissa J.; Rothberg, Brandon; Eslinger, Paul; Meaney, Christopher A.; Schneider, Ruth B.; Tang-Wai, David F.; Fox, Susan H.; Zadikoff, Cindy; Kennedy, Nancy; Chou, Kelvin L.; Persad, Carol; Litvan, Irene; Mast, Benjamin T.; Gerstenecker, Adam T.; Weintraub, Sandra; Reginold, William; Marras, Connie.

In: Dementia and Geriatric Cognitive Disorders, Vol. 47, No. 4-6, 01.10.2019, p. 187-197.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease

AU - Faust-Socher, Achinoam

AU - Duff-Canning, Sarah

AU - Grabovsky, Arthur

AU - Armstrong, Melissa J.

AU - Rothberg, Brandon

AU - Eslinger, Paul

AU - Meaney, Christopher A.

AU - Schneider, Ruth B.

AU - Tang-Wai, David F.

AU - Fox, Susan H.

AU - Zadikoff, Cindy

AU - Kennedy, Nancy

AU - Chou, Kelvin L.

AU - Persad, Carol

AU - Litvan, Irene

AU - Mast, Benjamin T.

AU - Gerstenecker, Adam T.

AU - Weintraub, Sandra

AU - Reginold, William

AU - Marras, Connie

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Clinical monitoring of patients with Parkinson's disease (PD) for cognitive decline is an important element of care. The Montreal Cognitive Assessment (MoCA) has been proposed to be a sensitive tool for assessing cognitive impairment in PD. The aim of our study was to compare the responsiveness of the MoCA to decline in cognition to the responsiveness of the Mini Mental State Examination (MMSE) and the Scales for Outcomes of Parkinson's disease-cognition (SCOPA-Cog). Methods: PD patients without dementia were enrolled at 6 North American movement disorders centers between 2008 and 2011. Participants received annual evaluations including the MoCA, MMSE, and SCOPA-Cog followed by formal neuropsychological testing. The gold standard for change in cognition was defined as the change on the neuropsychological test scores over the annual assessments. The Reliable Change Method was used to provide an estimate of the probability that a given difference score would be obtained by chance. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change was quantified using receiver operating characteristics (ROC) curves. Results: One hundred seventeen patients were included in the analysis. Participants were followed at mean intervals of 11 ± 2 months for a median of 2 (maximum 5) visits. According to the reliable change index, 56 intervals of cognitive testing showed a decline in global cognition. ROC analysis of change in MoCA, MMSE, and SCOPA-Cog global scores compared to gold standard testing found an area under the curve (AUC) of 0.55 (95% CI 0.48-0.62), 0.56 (0.48-0.63), and 0.63 (0.55-0.70) respectively. There were no significant differences in the AUCs across the tests. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change at various thresholds for decline in scores reached a maximum of 71% for a cut-off of 1 point change on the SCOPA-Cog. Conclusion: Using neuropsychological testing as a gold standard comparator, the performance of the MoCA, MMSE, and SCOPA-Cog for detecting decline in non-demented PD patients over a 1-year interval is poor. This has implications for clinical practice; stable scores may not be taken as reassurance of the absence of cognitive decline.

AB - Background: Clinical monitoring of patients with Parkinson's disease (PD) for cognitive decline is an important element of care. The Montreal Cognitive Assessment (MoCA) has been proposed to be a sensitive tool for assessing cognitive impairment in PD. The aim of our study was to compare the responsiveness of the MoCA to decline in cognition to the responsiveness of the Mini Mental State Examination (MMSE) and the Scales for Outcomes of Parkinson's disease-cognition (SCOPA-Cog). Methods: PD patients without dementia were enrolled at 6 North American movement disorders centers between 2008 and 2011. Participants received annual evaluations including the MoCA, MMSE, and SCOPA-Cog followed by formal neuropsychological testing. The gold standard for change in cognition was defined as the change on the neuropsychological test scores over the annual assessments. The Reliable Change Method was used to provide an estimate of the probability that a given difference score would be obtained by chance. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change was quantified using receiver operating characteristics (ROC) curves. Results: One hundred seventeen patients were included in the analysis. Participants were followed at mean intervals of 11 ± 2 months for a median of 2 (maximum 5) visits. According to the reliable change index, 56 intervals of cognitive testing showed a decline in global cognition. ROC analysis of change in MoCA, MMSE, and SCOPA-Cog global scores compared to gold standard testing found an area under the curve (AUC) of 0.55 (95% CI 0.48-0.62), 0.56 (0.48-0.63), and 0.63 (0.55-0.70) respectively. There were no significant differences in the AUCs across the tests. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change at various thresholds for decline in scores reached a maximum of 71% for a cut-off of 1 point change on the SCOPA-Cog. Conclusion: Using neuropsychological testing as a gold standard comparator, the performance of the MoCA, MMSE, and SCOPA-Cog for detecting decline in non-demented PD patients over a 1-year interval is poor. This has implications for clinical practice; stable scores may not be taken as reassurance of the absence of cognitive decline.

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