AD dementia affects over 55 million individuals worldwide and about 6.5 million Americans aged 65 and older. Approximately one-third of individuals with MCI progress to AD dementia within 5 years, while some may reverse to normal cognition. Mild cognitive impairment (MCI) is a clinical stage that falls between normal aging and dementia. A large underdiagnosis of the MCI and Alzheimer’s population still remains in clinical screening.Īlzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by a gradual and irreversible decline in cognitive function, accounting for 60% to 80% of dementia. The findings suggest that the ADAS-cog and MoCA are reliable tools for detecting AD and MCI, while the MMSE may be less sensitive in detecting these conditions. The estimated true prevalence of AD among individuals aged over 65 was 20.0%, and the estimated true prevalence of MCI due to AD was 24.8%. The ADAS-cog exhibited the highest sensitivity, closely followed by the MoCA and MMSE (0.869 vs 0.845 vs 0.757), and the ADAS-cog also had good specificity (0.835 vs 0.769 vs 0.721). For MCI detection, the ADAS-cog had the highest Youden's Index (0.704) compared to the MoCA (0.614) and MMSE (0.478). The ADAS-cog and MoCA showed similar sensitivity (0.922 vs 0.912) and specificity (0.907 vs 0.901), while the MMSE had lower sensitivity (0.874) and higher specificity (0.922). In detecting AD, the ADAS-cog had the highest Youden's Index (0.829), followed by the MoCA(0.813) and MMSE(0.796). Bayesian latent class models, accounting for conditional dependence between MoCA and MMSE, were conducted to assess the diagnostic accuracy of the three tests for detecting AD and MCI. MethodsĪ total of 1289 participants aged over 65 were included from the baseline visits of Alzheimer’s disease Neuroimaging Initiative. We aimed to accurately evaluate the discriminative ability of the three tests administrated at the same visit simultaneously in detecting AD and MCI due to AD in the absence of a gold standard. Neuropsychological testing, such as the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), is commonly used tests in identifying AD and MCI, offering convenience, affordability, non-invasiveness, and accessibility in clinical settings. In addition, the gold standard for diagnosing Mild Cognitive Impairment (MCI) remains unclear yet. ![]() These results should be viewed with some caution due to the use of the Cognistat as the gold standard.The neuropathological confirmation serves as the gold standard for diagnosing Alzheimer's disease (AD), but it is usually not available to the living individuals. ![]() The MMSE and the MoCA have relative strengths and weaknesses and neither emerged as a clearly superior tool however, the MoCA had a slightly better diagnostic accuracy than the MMSE. Intraclass correlation coefficients and kappa statistics were also calculated. ![]() ROC curves, sensitivity, specificity, positive and negative predictive values and positive likelihood ratios were analyzed. Age and side of stroke were abstracted in a chart review and patients were asked their level of education. A second Cognistat was administered by occupational therapists for the reliability sub-study. The MMSE and the MoCA were administered by occupational therapists and the Cognistat was administered by the student investigator. It was hypothesized that the MoCA is a superior screening instrument to the MMSE for the detection of cognitive impairment in stroke patients. This was a validation study of the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MoCA), using the Cognistat, as the criterion or ‘gold standard’. ![]() To identify the better of two commonly used screening tools for detecting probable cognitive impairment in stroke patients in a large regional rehabilitation hospital (ParkwoodHospital,London,Ontario).
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