Screening for very mild subcortical vascular dementia patients aged 75 and above using the montreal cognitive assessment and mini-mental state examination in a community: the kurihara project

Abstract

Aims: To examine the effectiveness of the Montreal Cognitive Assessment (MoCA) to screen people with mild cognitive impairment (MCI), to associate the MoCA score with the presence of infarction, and to detect the characteristics of people with very mild subcortical vascular dementia (vmSVD).

Methods: 392 out of 886 community dwellers aged 75 years and above living in Kurihara, Northern Japan, agreed to participate in our study; 164 scored a Clinical Dementia Rating (CDR) of 0 (healthy), 184 scored a CDR of 0.5 (MCI) and 44 scored a CDR of 1+ (dementia). The participants scoring a CDR of 0.5 were divided into 2 subtypes: 37 had vmSVD and 147 had other types of dementia. The objective variables were the total MoCA, the MoCA subscale and the Mini-Mental State Examination (MMSE).

Results: There was a difference in the MoCA and MMSE scores between the 3 CDR groups. The MoCA score overlapped in participants with CDR 0 and 0.5. There were significant CDR effects, while there were no significant infarction effects for the MoCA and MMSE. vmSVD participants had lower scores on the total MoCA, the MoCA attention subscale and MMSE than healthy elderly people and participants with other types of dementia.

Conclusion: Our results suggested that MMSE performed rather well and that the MoCA is not superior to MMSE in MCI and vmSVD participants aged 75 and above in a community.

Keywords: Clinical Dementia Rating; Community; Mild cognitive impairment; Montreal Cognitive Assessment; Subcortical vascular dementia.

Fig. 1

Protocol for the selection of participants.

Fig. 2

ROC analysis. a MoCA versus MMSE. ROC of the MoCA (thin black line) and MMSE (dashed black line) to distinguish participants with a CDR of 0.5 and more from those with a CDR of 0. b MoCA versus MMSE versus the combination of both MoCA attention subscale and MMSE. ROC of the MoCA (thin black line), MMSE (dashed black line), and the combination of both the MoCA attention subscale and MMSE (thick black line) to distinguish participants with vmSVD from those with a CDR of 0.

Fig. 3

Histogram of the participants with a CDR of 0 and a CDR of 0.5.

Fig. 4

The total MoCA and the MoCA attention subscale scores in healthy elderly, vmSVD and other types participants. a The total MoCA scores in the 3 groups. b The MoCA attention subscale scores in the 3 groups. * p = 0.05.