Is the Montreal Cognitive Assessment a suitable replacement for Mini Mental Status Examination in the detection of clinical cognitive deterioration?

Moses, Linda
Zambas, Shelaine
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Master of Health Science
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Auckland University of Technology

Background: Once situated within a care facility or acute hospital, cognitive impairment may be overlooked by the clinician. Early identification and intervention is critical not only in ameliorating symptoms but also in delaying or potentially arresting further cognitive decline. The Mini Mental State Exam (MMSE) has been the cognitive assessment tool of choice; however it is no longer freely available. The consistent use of a brief screening tool with similar or superior qualities, such as the Montreal Cognitive Assessment (MoCA) tool, is needed. Aim: To validate the utility of MoCA as a suitable alternative to MMSE in the detection of cognitive impairment. Methods: The PICO model was deployed to structure the research question and to guide the research design. Literature review was deemed to be an appropriate method for the purposes of this inquiry; articles retrieved were evaluated for inclusion using the critical skills analysis programme (CASP). Results: Sensitivity and specificity are pivotal to identifying the validity of a cognitive assessment tool, with the use of cut off scores critical to these values. MoCA was more sensitive than MMSE in the detection of cognitive impairment and this was particularly evident in the case of mild cognitive impairment where persons test as ‘normal’ using the MMSE but are identified as cognitively impaired using MoCA. Conclusion: Early intervention is key in extending quality of life for persons with cognitive impairment. Thus it was determined that MoCA is a valid brief cognitive assessment instrument and can be recommended for use by healthcare professionals in the early detection of mild cognitive decline.

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