Accuracy of the short form Montreal cognitive assessment – systematic review and validation

JA McDicken, G Blayney , Emma Elliot, Stephen Makin, Myzoon Ali, AJ Larner, Terry Quinn

Research output: Contribution to journalArticle

Abstract

Introduction
Short‐form versions of the Montreal Cognitive Assessment (SF‐MoCA) are increasingly used to screen for dementia in research and practice. We sought to collate evidence on the accuracy of SF‐MoCAs and to externally validate these assessment tools.
Methods
We performed systematic literature searching across multidisciplinary electronic literature databases, collating information on the content and accuracy of all published SF‐MoCAs. We then validated all the SF‐MoCAs against clinical diagnosis using independent stroke (n = 787) and memory clinic (n = 410) data sets.
Results
We identified 13 different SF‐MoCAs (21 studies, n = 6477 participants) with differing test content and properties. There was a pattern of high sensitivity across the range of SF‐MoCA tests. In the published literature, for detection of post stroke cognitive impairment, median sensitivity across included studies: 0.88 (range: 0.70‐1.00); specificity: 0.70 (0.39‐0.92). In our independent validation using stroke data, median sensitivity: 0.99 (0.80‐1.00); specificity: 0.40 (0.14‐0.87). To detect dementia in older adults, median sensitivity: 0.88 (0.62‐0.98); median specificity: 0.87 (0.07‐0.98) in the literature and median sensitivity: 0.96 (range: 0.72‐1.00); median specificity: 0.36 (0.14‐0.86) in our validation. Horton's SF‐MoCA (delayed recall, serial subtraction, and orientation) had the most favorable properties in stroke (sensitivity: 0.90, specificity: 0.87, positive predictive value [PPV]: 0.55, and negative predictive value [NPV]: 0.93), whereas Cecato's “MoCA reduced” (clock draw, animal naming, delayed recall, and orientation) performed better in the memory clinic (sensitivity: 0.72, specificity: 0.86, PPV: 0.55, and NPV: 0.93).
Conclusions
There are many published SF‐MoCAs. Clinicians and researchers using a SF‐MoCA should be explicit about the content. For all SF‐MoCA, sensitivity is high and similar to the full scale suggesting potential utility as an initial cognitive screening tool. However, choice of SF‐MoCA should be informed by the clinical population to be studied.
Original languageEnglish
Pages (from-to)1515-1525
Number of pages11
JournalInternational Journal of Geriatric Psychiatry
Volume34
Early online date2 Jul 2019
DOIs
Publication statusPublished - Oct 2019

Fingerprint

Stroke
Dementia
Sensitivity and Specificity
Research Personnel
Databases
Research
Population

Keywords

  • cognitive impairment
  • dementia
  • Montreal Cognitive Assessment
  • sensitivity
  • specificity

Cite this

McDicken, JA ; Blayney , G ; Elliot, Emma ; Makin, Stephen ; Ali, Myzoon ; Larner, AJ ; Quinn, Terry. / Accuracy of the short form Montreal cognitive assessment – systematic review and validation. In: International Journal of Geriatric Psychiatry. 2019 ; Vol. 34. pp. 1515-1525.
@article{6714769ec52b4531a45af3927aa8409a,
title = "Accuracy of the short form Montreal cognitive assessment – systematic review and validation",
abstract = "IntroductionShort‐form versions of the Montreal Cognitive Assessment (SF‐MoCA) are increasingly used to screen for dementia in research and practice. We sought to collate evidence on the accuracy of SF‐MoCAs and to externally validate these assessment tools.MethodsWe performed systematic literature searching across multidisciplinary electronic literature databases, collating information on the content and accuracy of all published SF‐MoCAs. We then validated all the SF‐MoCAs against clinical diagnosis using independent stroke (n = 787) and memory clinic (n = 410) data sets.ResultsWe identified 13 different SF‐MoCAs (21 studies, n = 6477 participants) with differing test content and properties. There was a pattern of high sensitivity across the range of SF‐MoCA tests. In the published literature, for detection of post stroke cognitive impairment, median sensitivity across included studies: 0.88 (range: 0.70‐1.00); specificity: 0.70 (0.39‐0.92). In our independent validation using stroke data, median sensitivity: 0.99 (0.80‐1.00); specificity: 0.40 (0.14‐0.87). To detect dementia in older adults, median sensitivity: 0.88 (0.62‐0.98); median specificity: 0.87 (0.07‐0.98) in the literature and median sensitivity: 0.96 (range: 0.72‐1.00); median specificity: 0.36 (0.14‐0.86) in our validation. Horton's SF‐MoCA (delayed recall, serial subtraction, and orientation) had the most favorable properties in stroke (sensitivity: 0.90, specificity: 0.87, positive predictive value [PPV]: 0.55, and negative predictive value [NPV]: 0.93), whereas Cecato's “MoCA reduced” (clock draw, animal naming, delayed recall, and orientation) performed better in the memory clinic (sensitivity: 0.72, specificity: 0.86, PPV: 0.55, and NPV: 0.93).ConclusionsThere are many published SF‐MoCAs. Clinicians and researchers using a SF‐MoCA should be explicit about the content. For all SF‐MoCA, sensitivity is high and similar to the full scale suggesting potential utility as an initial cognitive screening tool. However, choice of SF‐MoCA should be informed by the clinical population to be studied.",
keywords = "cognitive impairment, dementia, Montreal Cognitive Assessment, sensitivity, specificity",
author = "JA McDicken and G Blayney and Emma Elliot and Stephen Makin and Myzoon Ali and AJ Larner and Terry Quinn",
note = "Acceptance from webpage AAM req'd 14/11/19 DC ^Author notes this is not linked to GCU but part of Glasgow Uni work. Requested AAM again. ET 21/11/19",
year = "2019",
month = "10",
doi = "10.1002/gps.5162",
language = "English",
volume = "34",
pages = "1515--1525",
journal = "International Journal of Geriatric Psychiatry",
issn = "0885-6230",
publisher = "John Wiley & Sons",

}

Accuracy of the short form Montreal cognitive assessment – systematic review and validation. / McDicken, JA ; Blayney , G; Elliot, Emma; Makin, Stephen; Ali, Myzoon; Larner, AJ; Quinn, Terry.

In: International Journal of Geriatric Psychiatry, Vol. 34, 10.2019, p. 1515-1525.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Accuracy of the short form Montreal cognitive assessment – systematic review and validation

AU - McDicken, JA

AU - Blayney , G

AU - Elliot, Emma

AU - Makin, Stephen

AU - Ali, Myzoon

AU - Larner, AJ

AU - Quinn, Terry

N1 - Acceptance from webpage AAM req'd 14/11/19 DC ^Author notes this is not linked to GCU but part of Glasgow Uni work. Requested AAM again. ET 21/11/19

PY - 2019/10

Y1 - 2019/10

N2 - IntroductionShort‐form versions of the Montreal Cognitive Assessment (SF‐MoCA) are increasingly used to screen for dementia in research and practice. We sought to collate evidence on the accuracy of SF‐MoCAs and to externally validate these assessment tools.MethodsWe performed systematic literature searching across multidisciplinary electronic literature databases, collating information on the content and accuracy of all published SF‐MoCAs. We then validated all the SF‐MoCAs against clinical diagnosis using independent stroke (n = 787) and memory clinic (n = 410) data sets.ResultsWe identified 13 different SF‐MoCAs (21 studies, n = 6477 participants) with differing test content and properties. There was a pattern of high sensitivity across the range of SF‐MoCA tests. In the published literature, for detection of post stroke cognitive impairment, median sensitivity across included studies: 0.88 (range: 0.70‐1.00); specificity: 0.70 (0.39‐0.92). In our independent validation using stroke data, median sensitivity: 0.99 (0.80‐1.00); specificity: 0.40 (0.14‐0.87). To detect dementia in older adults, median sensitivity: 0.88 (0.62‐0.98); median specificity: 0.87 (0.07‐0.98) in the literature and median sensitivity: 0.96 (range: 0.72‐1.00); median specificity: 0.36 (0.14‐0.86) in our validation. Horton's SF‐MoCA (delayed recall, serial subtraction, and orientation) had the most favorable properties in stroke (sensitivity: 0.90, specificity: 0.87, positive predictive value [PPV]: 0.55, and negative predictive value [NPV]: 0.93), whereas Cecato's “MoCA reduced” (clock draw, animal naming, delayed recall, and orientation) performed better in the memory clinic (sensitivity: 0.72, specificity: 0.86, PPV: 0.55, and NPV: 0.93).ConclusionsThere are many published SF‐MoCAs. Clinicians and researchers using a SF‐MoCA should be explicit about the content. For all SF‐MoCA, sensitivity is high and similar to the full scale suggesting potential utility as an initial cognitive screening tool. However, choice of SF‐MoCA should be informed by the clinical population to be studied.

AB - IntroductionShort‐form versions of the Montreal Cognitive Assessment (SF‐MoCA) are increasingly used to screen for dementia in research and practice. We sought to collate evidence on the accuracy of SF‐MoCAs and to externally validate these assessment tools.MethodsWe performed systematic literature searching across multidisciplinary electronic literature databases, collating information on the content and accuracy of all published SF‐MoCAs. We then validated all the SF‐MoCAs against clinical diagnosis using independent stroke (n = 787) and memory clinic (n = 410) data sets.ResultsWe identified 13 different SF‐MoCAs (21 studies, n = 6477 participants) with differing test content and properties. There was a pattern of high sensitivity across the range of SF‐MoCA tests. In the published literature, for detection of post stroke cognitive impairment, median sensitivity across included studies: 0.88 (range: 0.70‐1.00); specificity: 0.70 (0.39‐0.92). In our independent validation using stroke data, median sensitivity: 0.99 (0.80‐1.00); specificity: 0.40 (0.14‐0.87). To detect dementia in older adults, median sensitivity: 0.88 (0.62‐0.98); median specificity: 0.87 (0.07‐0.98) in the literature and median sensitivity: 0.96 (range: 0.72‐1.00); median specificity: 0.36 (0.14‐0.86) in our validation. Horton's SF‐MoCA (delayed recall, serial subtraction, and orientation) had the most favorable properties in stroke (sensitivity: 0.90, specificity: 0.87, positive predictive value [PPV]: 0.55, and negative predictive value [NPV]: 0.93), whereas Cecato's “MoCA reduced” (clock draw, animal naming, delayed recall, and orientation) performed better in the memory clinic (sensitivity: 0.72, specificity: 0.86, PPV: 0.55, and NPV: 0.93).ConclusionsThere are many published SF‐MoCAs. Clinicians and researchers using a SF‐MoCA should be explicit about the content. For all SF‐MoCA, sensitivity is high and similar to the full scale suggesting potential utility as an initial cognitive screening tool. However, choice of SF‐MoCA should be informed by the clinical population to be studied.

KW - cognitive impairment

KW - dementia

KW - Montreal Cognitive Assessment

KW - sensitivity

KW - specificity

U2 - 10.1002/gps.5162

DO - 10.1002/gps.5162

M3 - Article

VL - 34

SP - 1515

EP - 1525

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

SN - 0885-6230

ER -