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. 2021 Jul 13;7(7):CD010775.
doi: 10.1002/14651858.CD010775.pub3.

Montreal Cognitive Assessment for the detection of dementia

Daniel Hj Davis  1 , Samuel T Creavin  2 , Jennifer Ly Yip  3 , Anna H Noel-Storr  4 , Carol Brayne  3 , Sarah Cullum  5
Affiliations

Montreal Cognitive Assessment for the detection of dementia

Daniel Hj Davis et al. Cochrane Database Syst Rev. .

Abstract

Background: Dementia is a progressive syndrome of global cognitive impairment with significant health and social care costs. Global prevalence is projected to increase, particularly in resource-limited settings. Recent policy changes in Western countries to increase detection mandates a careful examination of the diagnostic accuracy of neuropsychological tests for dementia.

Objectives: To determine the accuracy of the Montreal Cognitive Assessment (MoCA) for the detection of dementia.

Search methods: We searched MEDLINE, EMBASE, BIOSIS Previews, Science Citation Index, PsycINFO and LILACS databases to August 2012. In addition, we searched specialised sources containing diagnostic studies and reviews, including MEDION (Meta-analyses van Diagnostisch Onderzoek), DARE (Database of Abstracts of Reviews of Effects), HTA (Health Technology Assessment Database), ARIF (Aggressive Research Intelligence Facility) and C-EBLM (International Federation of Clinical Chemistry and Laboratory Medicine Committee for Evidence-based Laboratory Medicine) databases. We also searched ALOIS (Cochrane Dementia and Cognitive Improvement Group specialized register of diagnostic and intervention studies). We identified further relevant studies from the PubMed 'related articles' feature and by tracking key studies in Science Citation Index and Scopus. We also searched for relevant grey literature from the Web of Science Core Collection, including Science Citation Index and Conference Proceedings Citation Index (Thomson Reuters Web of Science), PhD theses and contacted researchers with potential relevant data.

Selection criteria: Cross-sectional designs where all participants were recruited from the same sample were sought; case-control studies were excluded due to high chance of bias. We searched for studies from memory clinics, hospital clinics, primary care and community populations. We excluded studies of early onset dementia, dementia from a secondary cause, or studies where participants were selected on the basis of a specific disease type such as Parkinson's disease or specific settings such as nursing homes.

Data collection and analysis: We extracted dementia study prevalence and dichotomised test positive/test negative results with thresholds used to diagnose dementia. This allowed calculation of sensitivity and specificity if not already reported in the study. Study authors were contacted where there was insufficient information to complete the 2x2 tables. We performed quality assessment according to the QUADAS-2 criteria. Methodological variation in selected studies precluded quantitative meta-analysis, therefore results from individual studies were presented with a narrative synthesis.

Main results: Seven studies were selected: three in memory clinics, two in hospital clinics, none in primary care and two in population-derived samples. There were 9422 participants in total, but most of studies recruited only small samples, with only one having more than 350 participants. The prevalence of dementia was 22% to 54% in the clinic-based studies, and 5% to 10% in population samples. In the four studies that used the recommended threshold score of 26 or over indicating normal cognition, the MoCA had high sensitivity of 0.94 or more but low specificity of 0.60 or less.

Authors' conclusions: The overall quality and quantity of information is insufficient to make recommendations on the clinical utility of MoCA for detecting dementia in different settings. Further studies that do not recruit participants based on diagnoses already present (case-control design) but apply diagnostic tests and reference standards prospectively are required. Methodological clarity could be improved in subsequent DTA studies of MoCA by reporting findings using recommended guidelines (e.g. STARDdem). Thresholds lower than 26 are likely to be more useful for optimal diagnostic accuracy of MoCA in dementia, but this requires confirmation in further studies.

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Conflict of interest statement

None.

Figures

1
1
Diagnostic pathways in dementia
2
2
Flow diagram for inclusion of articles in review
3
3
Flow diagram showing study selection, by setting. Reasons for exclusion: Not a DTA study 12; Mild cognitive impairment given as outcome 9; Not a MoCA study 6; Selected secondary care 84 (vascular dementia 31; Huntington's dementia 10; diabetes cohort 1; Parkinson's disease 41; nursing home cohort 1); Delayed‐verification 1; No dementia outcome 29; Reference standard not explicit 3; No normal controls 2; Duplicated data (abstract) 14; Case control design 11; Insufficient DTA data reported 1. Excluded studies that were considered in detail (including contact with authors) are fully referenced (n = 14).
4
4
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies
5
5
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study
6
6
Forest plot of MoCA in secondary care populations at different thresholds (above threshold considered normal). Thresholds are for reference thresholds (unadjusted).
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7
Forest plot of MoCA in community‐based populations at different thresholds (above threshold considered normal). Thresholds are for reference thresholds (unadjusted).
1
1. Test
MoCA Secondary care
2
2. Test
MoCA community based studies
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to studies excluded from this review

Aulwes 2012 {published and unpublished data}
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Magierska 2012 {published data only}
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Thissen 2010 {published and unpublished data}
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