Screening for Mild Cognitive Impairment: Comparison of "MCI Specific" Screening Instruments

Abstract

Background: Sensitive and specific instruments are required to screen for cognitive impairment (CI) in busy clinical practice. The Montreal Cognitive Assessment (MoCA) is widely validated but few studies compare it to tests designed specifically to detect mild cognitive impairment (MCI).

Objective: Comparison of two "MCI specific" screens: the Quick Mild Cognitive Impairment screen (Qmci) and MoCA.

Methods: Patients with subjective memory complaints (SMC; n = 73), MCI (n = 103), or dementia (n = 274), were referred to a university hospital memory clinic and underwent comprehensive assessment. Caregivers, without cognitive symptoms, were recruited as normal controls (n = 101).

Results: The Qmci was more accurate than the MoCA in differentiating MCI from controls, area under the curve (AUC) of 0.90 versus 0.80, p = 0.009. The Qmci had greater (AUC 0.81), albeit non-significant, accuracy than the MoCA (AUC 0.73) in separating MCI from SMC, p = 0.09. At its recommended cut-off (<62/100), the Qmci had a sensitivity of 90% and specificity of 87% for CI (MCI/dementia). Raising the cut-off to <65 optimized sensitivity (94%), reducing specificity (80%). At <26/30 the MoCA had better sensitivity (96%) but poor specificity (58%). A MoCA cut-off of <24 provided the optimal balance. Median Qmci administration time was 4.5 (±1.3) minutes compared with 9.5 (±2.8) for the MoCA.

Conclusions: Although both tests distinguish MCI from dementia, the Qmci is particularly accurate in separating MCI from normal cognition and has shorter administration times, suggesting it is more useful in busy hospital clinics. This study reaffirms the high sensitivity of the MoCA but suggests a lower cut-off (<24) in this setting.

Keywords: Cognitive screening; Montreal Cognitive Assessment; Quick Mild Cognitive Impairment screen; dementia; mild cognitive impairment.

Fig.1

Receiver Operating Characteristic curves demonstrating the accuracy of the Quick Mild Cognitive Impairment (Qmci) screen and Montreal Cognitive Assessment (MoCA) in differentiating (a) mild cognitive impairment (MCI) from normal controls, (b) MCI from subjective memory complaints (SMC), (c) MCI and dementia, (d) normal controls from cognitive impairment (MCI and dementia), (e) SMC from cognitive impairment, and (f) SMC from normal controls.

Fig.2

Comparison of the Receiver Operating Characteristic curves demonstrating the accuracy of the Quick Mild Cognitive Impairment (Qmci) screen and Montreal Cognitive Assessment (MoCA) in differentiating (a) mild cognitive impairment (MCI) from normal controls and (b) MCI from dementia. (note: data are adjusted for age and education)