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. 2021 Oct 4;21(1):485.
doi: 10.1186/s12888-021-03495-6.

A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study

Xiaofang Jia  1 , Zhihong Wang  1 , Feifei Huang  1 , Chang Su  1 , Wenwen Du  1 , Hongru Jiang  1 , Huijun Wang  1 , Jiaqi Wang  2 , Fangjun Wang  3 , Weiwu Su  4 , Huifang Xiao  5 , Yanxin Wang  6 , Bing Zhang  7
Affiliations

A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study

Xiaofang Jia et al. BMC Psychiatry. .

Abstract

Background: The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are the most commonly used scales to detect mild cognitive impairment (MCI) in population-based epidemiologic studies. However, their comparison on which is best suited to assess cognition is scarce in samples from multiple regions of China.

Methods: We conducted a cross-sectional analysis of 4923 adults aged ≥55 years from the Community-based Cohort Study on Nervous System Diseases. Objective cognition was assessed by Chinese versions of MMSE and MoCA, and total score and subscores of cognitive domains were calculated for each. Education-specific cutoffs of total score were used to diagnose MCI. Demographic and health-related characteristics were collected by questionnaires. Correlation and agreement for MCI between MMSE and MoCA were analyzed; group differences in cognition were evaluated; and multiple logistic regression model was used to clarify risk factors for MCI.

Results: The overall MCI prevalence was 28.6% for MMSE and 36.2% for MoCA. MMSE had good correlation with MoCA (Spearman correlation coefficient = 0.8374, p < 0.0001) and moderate agreement for detecting MCI with Kappa value of 0.5973 (p < 0.0001). Ceiling effect for MCI was less frequent using MoCA versus MMSE according to the distribution of total score. Percentage of relative standard deviation, the measure of inter-individual variance, for MoCA (26.9%) was greater than for MMSE (19.0%) overall (p < 0.0001). Increasing age (MMSE: OR = 2.073 for ≥75 years; MoCA: OR = 1.869 for≥75 years), female (OR = 1.280 for MMSE; OR = 1.163 for MoCA), living in county town (OR = 1.386 and 1.862 for MMSE and MoCA, respectively) or village (OR = 2.579 and 2.721 for MMSE and MoCA, respectively), smoking (OR = 1.373 and 1.288 for MMSE and MoCA, respectively), hypertension (MMSE: OR = 1.278; MoCA: OR = 1.208) and depression (MMSE: OR = 1.465; MoCA: OR = 1.350) were independently associated with greater likelihood of MCI compared to corresponding reference group in both scales (all p < 0.05).

Conclusions: MoCA is a better measure of cognitive function due to lack of ceiling effect and with good detection of cognitive heterogeneity. MCI prevalence is higher using MoCA compared to MMSE. Both tools identify concordantly modifiable factors for MCI, which provide important evidence for establishing intervention measures.

Keywords: Agreement; Correlation; MMSE; Mild cognitive impairment; MoCA; Risk factors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The correlation between the MMSE and MoCA total scores in Chinese population aged ≥55 years
Fig. 2
Fig. 2
Proportion of subjects with cognitive domain dysfunction by MMSE across strata of MoCA-assessed cognitive subscore. Cognitive domains included a executive function, b orientation, c calculation, d naming, e repetition, f visuoconstructional function, and g recall
See this image and copyright information in PMC

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References

    1. Jia L, Quan M, Fu Y, Zhao T, Li Y, Wei C, Tang Y, Qin Q, Wang F, Qiao Y, Shi S, Wang YJ, du Y, Zhang J, Zhang J, Luo B, Qu Q, Zhou C, Gauthier S, Jia J, Group for the Project of Dementia Situation in China Dementia in China: epidemiology, clinical management, and research advances. Lancet Neurol. 2020;19(1):81–92. doi: 10.1016/S1474-4422(19)30290-X. - DOI - PubMed
    1. Anderson ND. State of the science on mild cognitive impairment (MCI) CNS Spectr. 2019;24(1):78–87. doi: 10.1017/S1092852918001347. - DOI - PubMed
    1. Morley JE. An overview of cognitive impairment. Clin Geriatr Med. 2018;34(4):505–513. doi: 10.1016/j.cger.2018.06.003. - DOI - PubMed
    1. Sanford AM. Mild cognitive impairment. Clin Geriatr Med. 2017;33(3):325–337. doi: 10.1016/j.cger.2017.02.005. - DOI - PubMed
    1. Hawkins MA, Gathright EC, Gunstad J, Dolansky MA, Redle JD, Josephson R, et al. The MoCA and MMSE as screeners for cognitive impairment in a heart failure population: a study with comprehensive neuropsychological testing. Heart Lung. 2014;43(5):462–468. doi: 10.1016/j.hrtlng.2014.05.011. - DOI - PMC - PubMed

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