In sensitivity analyses we examined the stability of scores on the crosswalk when patients with delirium (n=40) were excluded. ( Figure 1) The crosswalk estimates were less stable at the lower end of scores, likely due in part to few patients scoring ≤10 on the MMSE. For instance, in-person MoCA scores ranged from 27–30 among patients who scored a 30 on the MMSE.
MOCA COGNITIVE TEST FULL
In addition, the full and abbreviated versions of the MoCA had more precision at higher levels of performance compared to the MMSE. Nine percent of patients achieved the maximum score on the MMSE while only 0.5% had a perfect score on the in-person MoCA. The MoCA was less limited by ceiling effects than the MMSE. MoCA = Montreal Cognitive Assessment Battery MMSE = Mini Mental State Examination MCI = Mild Cognitive Impairment Figure 1 presents a more detailed crosswalk for each score on the MMSE to corresponding scores on the MoCA and A-MoCA. For example, 70% of the sample had a score below 27 on the MMSE and the corresponding cut-point (i.e., the score under which approximately 70% of the sample fell) on the MoCA was 23 and on the A-MoCA was 17. As expected, scores in the same percentile ranking were lower on the MoCA compared to the MMSE. Clinically relevant cut-points on the MMSE and corresponding scores, based on percentile rankings, on the MoCA and A-MoCA are presented in Table 2. There was a high correlation between the MMSE and the MoCA (r=.84, 95% CI =.80–.88) and the A-MoCA (r=.82, 95% CI =.77–.86). Expectedly, scores on both tests are lower in patients with dementia and/or delirium. ( Table 1) Mean scores on the MMSE and MoCA are presented by cognitive (dementia) and delirium status in Appendix Table 1. The average score on the MMSE was 24 (SD=6, observed range =2–30), on the MoCA was 19 (SD=7 observed range =0–30) and on the A-MoCA was 14 (SD=5 observed range =0–22). Scores on the MMSE were higher, in general, than scores on the MoCA. MMSE range = 0–30 MoCA range = 0–30 Abbreviated MoCA 3 range = 0–22 SD = standard deviation ADL – Activities of Daily Living 14 IADL = Instrument Activities of Daily Living 15 MMSE = Mini Mental State Exam 1, MoCA = Montreal Cognitive, Assessment 2. We directly linked scores on the MMSE and MoCA in a sample of 199 inpatients, providing a crosswalk for scores on the full and abbreviated (using the items included in the telephone version) versions of the MoCA to corresponding scores on the MMSE. The MMSE, along with its well-established cut-points for impairment, has been used by frontline physicians and researchers for decades and a direct linkage of scores on the MoCA to the MMSE would help clinicians and researchers better understand patient scores on the increasingly popular MoCA.
4– 11 However, a direct linkage of scores and cut-points on the two measures does not exist. Prior studies have compared the sensitivity and specificity of the MoCA and MMSE in detecting MCI and dementia. 2 Recently, a telephone version of the MoCA has been validated, expanding the settings and circumstances in which patients can be evaluated. The MoCA has excellent sensitivity for MCI (90%) and mild Alzheimer’s disease (100%) compared to a clinical evaluation in a memory clinic. The Montreal Cognitive Assessment Battery (MoCA), 2 was developed for assessment of MCI and includes expanded assessments of visuospatial and executive function. In addition, the MMSE is limited in its ability to detect Mild Cognitive Impairment (MCI) and is not well validated for telephone administration. 1 However, the MMSE is now under copyright restrictions and is no longer freely available, potentially limiting routine use of the MMSE in clinical and research settings. The most widely used global cognitive screening instrument is the Mini Mental State Examination (MMSE). With increasing evidence from clinical and epidemiologic studies for an association between cognitive status and clinical, functional and quality of life outcomes, screening instruments for assessment of cognitive function have proliferated.
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