The Italian experience involving the MoCA is rather controversial, as is true for the vast majority of psychometric studies in the field of clinical neuropsychology. Moreover, some authors have suggested that the inclusion criteria applied in the original investigation for healthy participants (i.e., no cognitive complaints, scores within the normal range at neuropsychological assessment, no abnormalities detected during the neurological examination and CT scan in a subsample of 51 participants) have resulted in a “hyper-normal” control group, with clear repercussions on the cutoff setup. In this regard, the 1-point correction for participants with ≤ 12 years of education has been deemed inadequate for adjusting the nowadays known influence exerted by age and formal schooling, as evidenced by the different correction norms available. Nevertheless, several studies have reported an increased false positive rate by using this cutoff value, particularly in older and lower-educated participants. The originally suggested cutoff of 26 provided the best balance between sensitivity and specificity (0.90–1.00 and 0.87, respectively) in distinguishing MCI and AD patients from healthy controls. This is a 30-point screening battery that covers a wide range of cognitive domains, promoting a more in-depth and demanding assessment than MMSE, seemingly more sensitive in detecting patients with MCI and/or early-stage AD. developed the Montreal cognitive assessment (MoCA) to be coupled with MMSE during neuropsychological evaluation. To deal with such limitations, Nasreddine et al. However, the MMSE weighs heavily on linguistic capabilities, does not sufficiently explore the executive and visuo-spatial/-constructive domains, and may produce false negatives in case of subtle/mild cognitive defects. Since AD-modifying therapies might be effective only at stages preceding full-blown dementia, cognitive screening tools should be improved to help clinicians in discriminating between a physiological age-related cognitive decline and prodromal signs imputable to mild cognitive impairment (MCI).Īmong the available cognitive screening batteries, the Mini-mental state examination (MMSE ) is regarded internationally as a gold standard for assessing global cognitive functioning in moderate/advanced stages of dementia. Our optimal cutoffs can offset the poor sensitivity of Italian cutoffs.Įarly detection of cognitive impairment in the elderly has never been more relevant in neurological practice, even more so for the newly devised disease-modifying treatments for Alzheimer’s disease (AD), such as the recently FDA-approved Aducanumab. Using the 1-point correction, combined with a cutoff of 23.50, might be useful in ambulatory settings with a large turnout. The optimal cutoff for Nasreddine’s method was 23.50 (SE = 0.82 SP = 0.72 ). Nominal normative cutoffs (ES0 uLs) showed excellent specificity (SP range = 0.96–1.00 ) but poor sensitivity (SE range = 0.09–0.24 ). The original cutoff demonstrated high sensitivity (0.93 ) but low specificity (0.44 ) in discriminating between patients and controls. ROC curve analysis was performed to obtain optimal cutoffs. The diagnostic properties of the original cutoff (< 26) and normative cutoffs, namely, the upper limits (uLs) of equivalent scores (ES) 1, 2, and 3, were evaluated. Raw MoCA scores were adjusted according to the conventional 1-point correction (Nasreddine) and Italian norms (Conti, Santangelo, Aiello). Forty-five patients (24 PwMCI and 21 PwD) and 25 healthy controls were included. Retrospective data collection was performed for consecutive patients with clinically and biologically defined MCI and early dementia. In this phase II psychometric study on the Montreal cognitive assessment (MoCA), we tested the clinicometric properties of Italian norms for patients with mild cognitive impairment (PwMCI) and early dementia (PwD) and provided optimal cutoffs for diagnostic purposes.
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