Is the Montreal Cognitive Assessment (MoCA) screening superior to the Mini-Mental State Examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) in the elderly?

Tiago C C Pinto¹, Leonardo Machado¹, Tatiana M Bulgacov¹, Antônio L Rodrigues-Júnior¹, Maria L G Costa¹, Rosana C C Ximenes¹, Everton B Sougey¹

With the prevalence of dementia increasing, especially in the geriatric population, there is a growing emphasis on early diagnosis and intervention. Mild cognitive impairment is a cognitive disorder with characteristics that fall between normal cognition and dementia (decline in cognitive abilities and functions), often serving as a precursor to dementia, with an annual conversion rate ranging from 6% to 31%. Therefore, diagnosing mild cognitive impairment is essential for preventative and therapeutic interventions in the early stages of disease. The Mini-Mental State Examination has been the most widely used screening instrument for decades; however, newer assessments like the Montreal Cognitive Assessment, developed in 2005, are now available.

This study is a systematic review that investigates whether the Montreal Cognitive Assessment outperforms the Mini-Mental State Examination in identifying mild cognitive impairment and Alzheimer’s disease among the elderly. The review evaluated 34 studies comparing these tools for detecting mild cognitive impairment and Alzheimer’s disease. Results show that the Montreal Cognitive Assessment is generally superior in identifying mild cognitive impairment, especially in elderly individuals with lower educational backgrounds. Additionally, the Mini-Mental State Examination demonstrated lower accuracy among highly educated elderly individuals due to a “ceiling effect,” where educated individuals with mild cognitive impairment tend to score similarly to cognitively healthy individuals. This difference is likely due to the design of the Montreal Cognitive Assessment, which includes more complex items, such as cube drawing and clock drawing, and a longer delay time for recall, making the test more challenging and thus more sensitive to mild cognitive impairment.

Some studies noted that adjusting the cut-off scores based on education level could further improve the accuracy of the Montreal Cognitive Assessment, particularly for individuals with less formal education. Both tests, however, are effective in detecting Alzheimer’s disease.

Reference:

Pinto, T. C. C., Machado, L., Bulgacov, T. M., Rodrigues-Júnior, A. L., Costa, M. L. G., Ximenes, R. C. C., & Sougey, E. B. (2019). Is the Montreal Cognitive Assessment (MoCA) screening superior to the Mini-Mental State Examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) in the elderly?. International psychogeriatrics, 31(4), 491–504. https://doi.org/10.1017/S1041610218001370

MoCA-vs.-MMSE