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Neurological Sciences

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Open Access 28-09-2022 | Dementia | Original Article

Optimal MoCA cutoffs for detecting biologically-defined patients with MCI and early dementia

Authors: Ciro Rosario Ilardi, Alina Menichelli, Marco Michelutti, Tatiana Cattaruzza, Paolo Manganotti

Published in: Neurological Sciences | Issue 1/2023

Abstract

Objective

In this phase II psychometric study on the Montreal cognitive assessment (MoCA), we tested the clinicometric properties of Italian norms for patients with mild cognitive impairment (PwMCI) and early dementia (PwD) and provided optimal cutoffs for diagnostic purposes.

Methods

Retrospective data collection was performed for consecutive patients with clinically and biologically defined MCI and early dementia. Forty-five patients (24 PwMCI and 21 PwD) and 25 healthy controls were included. Raw MoCA scores were adjusted according to the conventional 1-point correction (Nasreddine) and Italian norms (Conti, Santangelo, Aiello). The diagnostic properties of the original cutoff (< 26) and normative cutoffs, namely, the upper limits (uLs) of equivalent scores (ES) 1, 2, and 3, were evaluated. ROC curve analysis was performed to obtain optimal cutoffs.

Results

The original cutoff demonstrated high sensitivity (0.93 [95% CI 0.84–0.98]) but low specificity (0.44 [0.32–0.56]) in discriminating between patients and controls. Nominal normative cutoffs (ES0 uLs) showed excellent specificity (SP range = 0.96–1.00 [0.88–1.00]) but poor sensitivity (SE range = 0.09–0.24 [0.04–0.36]). The optimal cutoff for Nasreddine’s method was 23.50 (SE = 0.82 [0.71–0.90]; SP = 0.72 [0.60–0.82]). Optimal cutoffs were 20.97, 22.85, and 22.29 (SE range = 0.69–0.73 [0.57–0.83], SP range = 0.88–0.92 [0.77–0.97]) for Conti’s, Santangelo’s, and Aiello’s methods, respectively.

Conclusion

Using the 1-point correction, combined with a cutoff of 23.50, might be useful in ambulatory settings with a large turnout. Our optimal cutoffs can offset the poor sensitivity of Italian cutoffs.

Available only for authorised users

Note that the lower optimal cutoff for Conti’s method is probably the result of severer correction factors (i.e., they reward less and penalize more), given the normative sample including only elderly people [9].

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Title: Optimal MoCA cutoffs for detecting biologically-defined patients with MCI and early dementia
Authors: Ciro Rosario Ilardi
Alina Menichelli
Marco Michelutti
Tatiana Cattaruzza
Paolo Manganotti
Publication date: 28-09-2022
Publisher: Springer International Publishing
Keywords: Dementia
Dementia
Mild Neurocognitive Disorder
Published in: Neurological Sciences / Issue 1/2023
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-022-06422-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Optimal MoCA cutoffs for detecting biologically-defined patients with MCI and early dementia

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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