Lara Alves

Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease.

The Montreal Cognitive Assessment (MoCA) was recently proposed as a cognitive screening test for milder forms of cognitive impairment, having surpassed the well-known limitations of the Mini-Mental State Examination (MMSE). This study aims to validate the MoCA for screening Mild Cognitive Impairment (MCI) and Alzheimer disease (AD) through an analysis of diagnostic accuracy and the proposal of cut-offs. Patients were classified into 2 clinical groups according to standard criteria: MCI (n=90) and AD (n=90). The 2 control groups (C-MCI: n=90; C-AD: n=90) consisted of cognitively healthy community dwellers selected to match patients in sex, age, and education. The MoCA showed consistently superior psychometric properties compared with the MMSE, and higher diagnostic accuracy to discriminate between MCI (area under the curve=0.856; 95% confidence interval, 0.796-0.904) and AD patients (area under the curve=0.980; 95% confidence interval, 0.947-0.995). At an optimal cut-off of below 22 for MCI and below 17 for AD, the MoCA achieved significantly superior values in comparison with MMSE for sensitivity, specificity, positive predictive value, negative predictive value, and classification accuracy. Furthermore, the MoCA revealed higher sensitivity to cognitive decline in longitudinal monitoring. This study provides robust evidence that the MoCA is a better cognitive tool than the widely used MMSE for the screening and monitoring of MCI and AD in clinical settings.

Montreal Cognitive Assessment (MoCA): Normative study for the Portuguese population

The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument with good psychometric features and an excellent sensitivity in the early detection of mild cognitive decline. The MoCA was applied to a community-based sample of cognitively healthy adults (n = 650), stratified according to sociodemographic variables (age, gender, educational level, geographic region, geographic localization, and residence area), with a distribution similar to that observed in the Portuguese population. The normative data were determined according to age and education as these were the sociodemographic variables that most significantly contributed to the prediction of the MoCA scores, explaining 49% of their variance.

Montreal Cognitive Assessment (MoCA): Validation Study for Vascular Dementia

The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the MMSE. The aim of the present study was to validate the MoCA as well as its short version, which was proposed by the NINDS-CSN VCI Harmonization Standards for screening Vascular Dementia (VaD) patients. The results, based on a homogeneous sample of 34 VaD patients, indicate that the MoCA is a psychometrically valid and reliable instrument for cognitive screening in VaD patients, showing excellent discriminant validity. Both the full and short versions of the MoCA had excellent diagnostic accuracy in discriminating VaD patients, exhibiting an area under curve (AUC) higher than the MMSE [AUC(MoCA full version) = .950; 95% IC = .868-.988; AUC(MoCA short version) = .936; 95% IC = .849-.981; AUC(MMSE) = .860; 95% IC = .754-.932]. With a cutoff below 17 on the MoCA full version and 8 on the short version, the results for sensitivity, specificity, positive and negative predictive values, and classification accuracy were superior compared to the MMSE. In conclusion, both versions of the MoCA are valid, reliable, sensitive and accurate screening instruments for VaD patients.

Montreal Cognitive Assessment (MoCA): Validation study for Frontotemporal Dementia:

The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the Mini-Mental State Examination (MMSE). The aim of the present study was to validate the MoCA as a cognitive screening test for behavioral-variant frontotemporal dementia (bv-FTD) by examining its psychometric properties and diagnostic accuracy. Three matched subgroups of participants were considered: bv-FTD (n = 50), Alzheimer disease (n = 50), and a control group of healthy adults (n = 50). Compared with the MMSE, the MoCA demonstrated consistently superior psychometric properties and discriminant capacity, providing comprehensive information about the patients’ cognitive profiles. The diagnostic accuracy of MoCA for bv-FTD was extremely high (area under the curve AUC [MoCA] = 0.934, 95% confidence interval [CI] = 0.866-.974; AUC [MMSE] = 0.772, 95% CI = 0.677-0.850). With a cutoff below 17 points, the MoCA results for sensitivity, specificity, positive predictive value, negative predictive value, and classification accuracy were significantly superior to those of the MMSE. The MoCA is a sensitive and accurate instrument for screening the patients with bv-FTD and represents a better option than the MMSE.

The Estimation of Premorbid Intelligence Levels among Portuguese Speakers: The Irregular Word Reading Test (TeLPI)

Information regarding cognitive abilities in earlier stages of life is essential to ascertain if and to what extent these may have declined. When unavailable, clinicians rely on estimate methods. One of the contemporary methods used worldwide combines performance on irregular word reading test with demographics since it has shown to provide reliable estimates of premorbid ability. Hence, a reading test portuguese irregular word reading test (TeLPI) was developed, filling an important gap in the neuropsychological evaluation of Portuguese speakers. Using 46 irregular, infrequent Portuguese words, TeLPI was validated against Wechsler Adult Intelligence Scale (WAIS)-III (N = 124), and regression-based equations were determined to estimate premorbid IQ considering TeLPI scores and demographic variables. TeLPI scores accounted for 63% of the variance of WAIS-III Full-Scale IQ, 62% of Verbal IQ, and 47% of Performance IQ and thus were considered valid for premorbid intelligence estimation.

Premorbid IQ Influence on Screening Tests’ Scores in Healthy Patients and Patients With Cognitive Impairment

Cognitive screening tests are well-established tools for detecting cognitive impairment, but concerns regarding the influence of premorbid intelligence on patient’s performance and cognitive status classification remain. Risk of inaccurate assessment especially affects the elders with high or low premorbid intelligence (who are more likely to be misclassified). The present study examines the influence of premorbid intelligence assessed by the TeLPI (an irregular words reading test) on 2 cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), in healthy participants and patients with cognitive impairments (mild cognitive impairment and Alzheimer disease). Results show that premorbid IQ influences the MMSE and the MoCA scores in both the groups, predicting variance from 8.4% to 33.2%, according to test and group analyzed. Hence, we propose that whenever the MMSE or the MoCA is used, premorbid IQ evaluation should also be considered to ensure correct interpretation and classification.

The Relevance of Sociodemographic and Health Variables on MMSE Normative Data

The Mini Mental State Examination (MMSE) is the most broadly used cognitive screening instrument in clinical and research contexts. The MMSE was administered to a community-based sample of cognitively healthy adults (n = 850), stratified according to several sociodemographic variables, with a distribution similar to that observed in the Portuguese population. This study aimed to analyze the influence of sociodemographic (age, gender, education level, marital and employment status, geographic region, geographic localization, and residence area) and health variables (subjective memory complaints of the participant and evaluated by the informant, depressive symptoms, and family history of dementia) on the participants’ performance on the MMSE and to establish normative data for the Portuguese population. Education level and age significantly contributed to the prediction of the MMSE scores and explained 26% of its variance. Regarding health variables, only the subjective memory complaints of the participant showed a small contribution (4%) to the variance of the MMSE scores. According to these results, age and education were considered in the development of the normative data of the MMSE for the Portuguese population.

The Clock Drawing Test: Portuguese norms, by age and education, for three different scoring systems.

The Clock Drawing Test has been systematically used to assess visuospatial deficits related to the parietal lobes, but we now acknowledge its much more complex relation with other cognitive abilities. Despite its common use in clinical and investigational practices, no study has developed normative data for the Portuguese population. We present the distribution of clock drawing scores using three scoring systems in a representative community sample of cognitively healthy subjects. We found that the systems were well correlated with each other and with cognitive screening tests widely used and had good psychometric properties. Normative data for the three scoring systems were developed considering age and education. These results allow a more rigorous interpretation of the test performance in clinical context and are especially relevant for epidemiological research.

TeLPI performance in subjects with mild cognitive impairment and Alzheimer disease: a validation study.

APA guidelines for the evaluation of age-related cognitive decline and dementia emphasize the need for baseline (premorbid) data against which current performance can be compared. As this information rarely exists, clinicians must rely on instruments especially designed for estimation of premorbid abilities. No such instrument was available in Portugal until the development of the TeLPI, an irregular words oral reading test. This study aims to examine TeLPI’s validity as a measure of premorbid ability in the spectrum of aging cognitive decline, from mild cognitive impairment (MCI) to moderate Alzheimer disease (AD), by the analysis of its stability in normal versus impaired samples. A total of 104 patients, classified into 2 clinical groups, MCI (n=53) and probable mild to moderate AD (n=51), were compared with a group of cognitively healthy controls (C_MCI: n=53; C_AD: n=51) and matched for sex, age, education, and residence. As expected, the Mini-Mental State Examination and Montreal Cognitive Assessment results were significantly different between the groups (AD<MCI<controls), reflecting the severity of cognitive impairment. TeLPI median scores of controls, MCI, and probable AD patients were comparable after correcting for years of education, revealing no significant effect of cognitive impairment on TeLPI performance, and suggesting its validity for estimating premorbid intelligence in subjects with cognitive decline and dementia.

Premorbid Intelligence Evaluation: development of the experimental version of the Irregular Words Reading Test (TeLPI) for Portuguese Population

In order to establish a patient´s cognitive decline and in the absence of objective information on the patient´s prior level of functioning, clinicians have to rely on methods of premorbid intelligence estimation. This assessment is clinically essential when trying to define the existence, degree, extension and course of injuries with potential cognitive decline. Recent work in this area interconnects the current capacity to read irregular words to current rates of intelligence and demographic variables, using regression formulas. The frequent use of premorbid intelligence estimation tests in neuropsychological examination protocols justifies the construction of an analogous test for the Portuguese population. Therefore, with the objective of creating a trustworthy instrument of premorbid intelligence estimation, the first experimental version of TeLPI was developed, constituted by 121 Portuguese irregular words (105 infrequent, and 16 frequent). This study presents the methodology of construction of TeLPI, its item selection and the future challenges for the establishment of its final version.