Universität zu Köln

Fengler, Sophie, Kessler, Josef, Timmermann, Lars, Zapf, Alexandra, Elben, Saskia, Wojtecki, Lars, Tucha, Oliver and Kalbe, Elke (2016). Screening for Cognitive Impairment in Parkinson's Disease: Improving the Diagnostic Utility of the MoCA through Subtest Weighting. PLoS One, 11 (7). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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Abstract

Background Given the high prevalence of cognitive impairment in Parkinson's disease (PD), cognitive screening is important in clinical practice. The Montreal Cognitive Assessment (MoCA) is a frequently used screening test in PD to detect mild cognitive impairment (PD-MCI) and Parkinson's disease dementia (PD-D). However, the proportion in which the subtests are represented in the MoCA total score does not seem reasonable. We present the development and preliminary evaluation of an empirically based alternative scoring system of the MoCA which aims at increasing the overall diagnostic accuracy. Methods In study 1, the MoCA was administered to 40 patients with PD without cognitive impairment (PD-N), PD-MCI, or PD-D, as defined by a comprehensive neuropsychological test battery. The new MoCA scoring algorithm was developed by defining Areas under the Curve (AUC) for MoCA subtests in a Receiver Operating Characteristic (ROC) and by weighting the sub-tests according to their sensitivities and specificities. In study 2, an independent sample of 24 PD patients (PD-N, PD-MCI, or PD-D) was tested with the MoCA. In both studies, diagnostic accuracy of the original and the new scoring procedure was calculated. Results Diagnostic accuracy increased with the new MoCA scoring algorithm. In study 1, the sensitivity to detect cognitive impairment increased from 62.5% to 92%, while specificity decreased only slightly from 77.7% to 73%; in study 2, sensitivity increased from 68.8% to 81.3%, while specificity stayed stable at 75%. Conclusion This pilot study demonstrates that the sensitivity of the MoCA can be enhanced substantially by an empirically based weighting procedure and that the proposed scoring algorithm may serve the MoCA's actual purpose as a screening tool in the detection of cognitive dysfunction in PD patients better than the original scoring of the MoCA. Further research with larger sample sizes is necessary to establish efficacy of the alternate scoring system.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Fengler, Sophie UNSPECIFIED UNSPECIFIED UNSPECIFIED Kessler, Josef UNSPECIFIED UNSPECIFIED UNSPECIFIED Timmermann, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Zapf, Alexandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Elben, Saskia UNSPECIFIED UNSPECIFIED UNSPECIFIED Wojtecki, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Tucha, Oliver UNSPECIFIED UNSPECIFIED UNSPECIFIED Kalbe, Elke UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-269728
DOI:	10.1371/journal.pone.0159318
Journal or Publication Title:	PLoS One
Volume:	11
Number:	7
Date:	2016
Publisher:	PUBLIC LIBRARY SCIENCE
Place of Publication:	SAN FRANCISCO
ISSN:	1932-6203
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MINI-MENTAL-STATE; SOCIETY TASK-FORCE; QUALITY-OF-LIFE; EXECUTIVE DYSFUNCTION; VISUAL DYSFUNCTION; DEMENTIA; INSTRUMENTS; DEPRESSION; MMSE; DISABILITY Multiple languages Multidisciplinary Sciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/26972