TY - JOUR
T1 - Comparison of Mini-Mental State Examination and Montreal Cognitive Assessment Ratings across Levels of Parkinson's Disease Severity
AU - Snyder, Allison
AU - Gruber-Baldini, Ann L.
AU - Rainer Von Coelln, F.
AU - Savitt, Joseph M.
AU - Reich, Stephen G.
AU - Armstrong, Melissa J.
AU - Shulman, Lisa M.
N1 - Funding Information:
This research was conducted at the University of Maryland Parkinson Disease and Movement Disorders Center as part of the HOME (Health Outcomes Measurement) Study and is supported by The Rosalyn Newman Foundation.
Funding Information:
AGB: The author has no conflict of interest to report. Dr. Gruber-Baldini receives grant funding from the National Institutes of Health (R01AG059 651; R01 AG059651, P30 AG028747-13S3, T32 AG000262, R21) and a grant from Gilead Science, Inc.
Funding Information:
SGR: The author receives grant support from the NINDS; book royalties from Springer, Oxford, Informa; chair of the Data Safety Monitoring Board for Enterin; reviewer for UpToDate; Consultant for Best Doctors MJA: The author receives research support from the NIA (R01AG068128, P30AG047266), the Florida Department of Health (grant 20A08), and as the local PI of a Lewy Body Dementia Association Research Center of Excellence. She receives royalties from the publication of the book Parkinson’s Disease: Improving Patient Care and she has received honoraria for presenting at AAN and International Parkinson and Movement Disorder Society annual meetings.
Publisher Copyright:
© 2021 - IOS Press. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background: Cognitive impairment (CI) is common in Parkinson's disease (PD) and an important cause of disability. Screening facilitates early detection of CI and has implications for management. Preclinical disability is when patients have functional limitations but maintain independence through compensatory measures. Objective: The objective of this study was to investigate the relationship between scores on the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) with levels of PD severity and disability. Methods: PD patients (n = 2,234) in a large observational study were stratified by disease severity, based on Total Unified Parkinson's Disease Rating Scale (Total UPDRS) and Hoehn and Yahr (HY) stage. Using MMSE (n = 1,184) or MoCA (n = 1,050) and basic (ADL) and instrumental activities of daily living (IADL) scales for disability, linear regression analysis examined associations between cognitive status and disability. Results: Cognition and disability were highly correlated, with the strongest correlation between IADL and MoCA. Only 16.0% of mean MMSE scores were below threshold for CI (28) and only in advanced PD (Total UPDRS 60+, HY≥3). MoCA scores fell below CI threshold (26) in 66.2% of the sample and earlier in disease (Total UPDRS 30+, HY≥2), corresponding with impairments in ADLs. Conclusion: In a large clinical dataset, a small fraction of MMSE scores fell below cutoff for CI, reinforcing that MMSE is an insensitive screening tool in PD. MoCA scores indicated CI earlier in disease and coincided with disability. This study shows that MoCA, but not MMSE is sensitive to the emergence of early cognitive impairment in PD and correlates with the concomitant onset of disability.
AB - Background: Cognitive impairment (CI) is common in Parkinson's disease (PD) and an important cause of disability. Screening facilitates early detection of CI and has implications for management. Preclinical disability is when patients have functional limitations but maintain independence through compensatory measures. Objective: The objective of this study was to investigate the relationship between scores on the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) with levels of PD severity and disability. Methods: PD patients (n = 2,234) in a large observational study were stratified by disease severity, based on Total Unified Parkinson's Disease Rating Scale (Total UPDRS) and Hoehn and Yahr (HY) stage. Using MMSE (n = 1,184) or MoCA (n = 1,050) and basic (ADL) and instrumental activities of daily living (IADL) scales for disability, linear regression analysis examined associations between cognitive status and disability. Results: Cognition and disability were highly correlated, with the strongest correlation between IADL and MoCA. Only 16.0% of mean MMSE scores were below threshold for CI (28) and only in advanced PD (Total UPDRS 60+, HY≥3). MoCA scores fell below CI threshold (26) in 66.2% of the sample and earlier in disease (Total UPDRS 30+, HY≥2), corresponding with impairments in ADLs. Conclusion: In a large clinical dataset, a small fraction of MMSE scores fell below cutoff for CI, reinforcing that MMSE is an insensitive screening tool in PD. MoCA scores indicated CI earlier in disease and coincided with disability. This study shows that MoCA, but not MMSE is sensitive to the emergence of early cognitive impairment in PD and correlates with the concomitant onset of disability.
KW - Parkinson's disease
KW - cognitive impairment
KW - cognitive screening
KW - disability
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U2 - 10.3233/jpd-212705
DO - 10.3233/jpd-212705
M3 - Article
C2 - 34366371
AN - SCOPUS:85117380761
SN - 1877-7171
VL - 11
SP - 1995
EP - 2003
JO - Journal of Parkinson's Disease
JF - Journal of Parkinson's Disease
IS - 4
ER -