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 J 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

doi: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

Dement Geriatr Cogn Disord. 2019;47(4-6):187-197. doi: 10.1159/000496454. Epub 2019 Jul 17.

Authors

Achinoam Faust-Socher^{1

2}, Sarah Duff-Canning¹, Arthur Grabovsky³, Melissa J Armstrong⁴, Brandon Rothberg¹, Paul J Eslinger⁵, Christopher A Meaney⁶, Ruth B Schneider⁷, David F Tang-Wai⁸, Susan H Fox¹, Cindy Zadikoff⁹, Nancy Kennedy¹⁰, Kelvin L Chou¹¹, Carol Persad¹², Irene Litvan¹³, Benjamin T Mast¹⁴, Adam T Gerstenecker¹⁵, Sandra Weintraub¹⁶, William Reginold¹, Connie Marras¹⁷

Affiliations

¹ The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, Ontario, Canada.
² Movement Disorders Unit, Tel Aviv Medical Center, Tel Aviv, Israel.
³ Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, USA.
⁵ Departments of Neurology, Neural and Behavioral Sciences, and Radiology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
⁶ Division of Biostatistics, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.
⁸ Division of Neurology, University Health Network Memory Clinic, University of Toronto, Toronto, Ontario, Canada.
⁹ Department of Neurology, Northwestern University, Chicago, Illinois, USA.
¹⁰ Department of Psychiatry and Behavioral Science, Northwestern University, Chicago, Illinois, USA.
¹¹ Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
¹² Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
¹³ Parkinson and Other Movement Disorders Center, Department of Neuroscience, UC San Diego, San Diego, California, USA.
¹⁴ Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA.
¹⁵ Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁶ Department of Psychiatry and Behavioural Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁷ The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, Ontario, Canada, connie.marras@utoronto.ca.

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.

Keywords: Cognitive decline; Mild cognitive impairment; Parkinson’s disease; Responsiveness.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Cognition
Cognitive Dysfunction / diagnosis
Cognitive Dysfunction / etiology
Cognitive Dysfunction / psychology
Dementia / diagnosis
Dementia / etiology
Dementia / psychology*
Disease Progression
Female
Humans
Male
Mental Status and Dementia Tests
Middle Aged
Neuropsychological Tests*
Parkinson Disease / complications
Parkinson Disease / diagnosis
Parkinson Disease / psychology*
ROC Curve
Reproducibility of Results
Sensitivity and Specificity

Grants and funding

P30 AG013854/AG/NIA NIH HHS/United States