Montreal Cognitive Assessment and Mini–Mental State Examination are both valid cognitive tools in stroke
Article first published online: 21 FEB 2013
© 2013 John Wiley & Sons A/S
Acta Neurologica Scandinavica
Volume 128, Issue 2, pages 122–129, August 2013
How to Cite
MoCA and MMSE are both valid cognitive tools in stroke. Acta Neurol Scand 2013: 128: 122‒129. © 2013 John Wiley & Sons A/S., , , .
- Issue published online: 9 JUL 2013
- Article first published online: 21 FEB 2013
- Manuscript Accepted: 14 DEC 2012
- National Stroke Foundation
- Equity Trustees Preston & Loui Geduld Trust Fund
- cerebrovascular disease;
- cognitive impairment;
To determine the validity of the Montreal Cognitive Assessment (MoCA) and the Mini–Mental State Examination (MMSE) as screening tools for cognitive impairment after stroke.
Materials and methods
Cognitive assessments were administered over 2 sessions (1 week apart) at 3 months post-stroke. Scores on the MoCA and MMSE were evaluated against a diagnosis of cognitive impairment derived from a comprehensive neuropsychological battery (the criterion standard).
Sixty patients participated in the study [mean age 72.1 years (SD = 13.9), mean education 10.5 years (SD = 3.9), median acute NIHSS score 5 (IQR 3–7)]. The MoCA yielded lower scores (median = 21, IQR = 17–24; mean = 20.0, SD = 5.4) than the MMSE (median = 26, IQR = 22–27; mean = 24.2, SD = 4.5). MMSE data were more skewed towards ceiling than MoCA data (skewness = −1.09 vs −0.73). Area under the receiver operator curve was higher for MoCA than for MMSE (0.87 vs 0.84), although this difference was not significant (χ2 = 0.48, P = 0.49). At their optimal cut-offs, the MoCA had better sensitivity than the MMSE (0.92 vs 0.82) but poorer specificity (0.67 vs 0.76).
The MoCA is a valid screening tool for post-stroke cognitive impairment; it is more sensitive but less specific than the MMSE. Contrary to the prevailing view, the MMSE also exhibited acceptable validity in this setting.