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. 2023 Oct;35(10):2157-2163.
doi: 10.1007/s40520-023-02493-w. Epub 2023 Jul 22.

Validity and diagnostics of the Italian version of the Montreal Cognitive Assessment (MoCA) in non-demented Parkinson's disease patients

Alfonsina D'Iorio #  1 , Edoardo Nicolò Aiello #  2 , Marianna Amboni  3   4 , Carmine Vitale  3   5 , Federico Verde  2   6 , Vincenzo Silani  2   6 , Nicola Ticozzi  2   6 , Andrea Ciammola  2 , Barbara Poletti #  2   7 , Gabriella Santangelo #  8
Affiliations

Validity and diagnostics of the Italian version of the Montreal Cognitive Assessment (MoCA) in non-demented Parkinson's disease patients

Alfonsina D'Iorio et al. Aging Clin Exp Res. 2023 Oct.

Abstract

Background: This study aimed at: (1) assessing, in an Italian cohort of non-demented Parkinson's disease (PD) patients, the construct validity of the Montreal Cognitive Assessment (MoCA) against both first- and second-level cognitive measures; (2) delivering an exhaustive and updated evaluation of its diagnostic properties.

Methods: A retrospective cohort of N = 237 non-demented PD patients having been administered the MoCA was addressed, of whom N = 169 further underwent the Mini-Mental State Examination (MMSE) and N = 68 the Parkinson's Disease Cognitive Rating Scale (PD-CRS). A subsample (N = 60) also underwent a second-level cognitive battery encompassing measures of attention/executive functioning, language, memory, praxis and visuo-spatial abilities. Construct validity was assessed against both the PD-CRS and the second-level cognitive battery. Diagnostics were tested via receiver-operating characteristics analyses against a below-cut-off MMSE score.

Results: The MoCA was associated with both PD-CRS scores (p < .001) and the vast majority of second-level cognitive measures (ps < .003). Both raw and adjusted MoCA scores proved to be highly accurate to the aim of identifying patients with MMSE-confirmed cognitive dysfunctions. A MoCA score adjusted for age and education according to the most recent normative dataset and < 19.015 is herewith suggested as indexing cognitive impairment in this population (AUC = .92; sensitivity = .92; specificity = .80).

Discussion: The Italian MoCA is a valid and diagnostically sound screener for global cognitive inefficiency in non-demented PD patients. Further studies are nevertheless needed that confirm its diagnostic values against a measure other than the MMSE.

Keywords: Cognitive screening; Montreal Cognitive Assessment; Neuropsychology; Parkinson’s disease.

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Conflict of interest statement

AD, ENA, MA, CV, FV, AC and GS declare that they have no conflict of interests. VS received compensation for consulting services and/or speaking activities from AveXis, Cytokinetics, Italfarmaco, Liquidweb S.r.l., and Novartis Pharma AG, receives or has received research supports from the Italian Ministry of Health, AriSLA, and E-Rare Joint Transnational Call. He is in the Editorial Board of Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, European Neurology, American Journal of Neurodegenerative Diseases, Frontiers in Neurology and Exploration of Neuroprotective Therapy. BP received compensation for consulting services and/or speaking activities from Liquidweb S.r.l BP is Associated Editor for Frontiers in Neuroscience. NT received compensation for consulting services from Amylyx Pharmaceuticals and Zambon Biotech SA. He is Associate Editor for Frontiers in Aging Neuroscience.

Figures

Fig. 1
Fig. 1
Flowchart displaying the tests administered to each patient subsample. MoCA Montreal Cognitive Assessment, MMSE Mini-Mental State Examination, PD-CRS Parkinson’s Disease Cognitive Rating Scale
Fig. 2
Fig. 2
ROC curves for raw and adjusted MoCA against a defective MMSE score. Notes. ROC = receiver-operating characteristics; MoCA = Montreal Cognitive Assessment; MMSE = Mini-Mental State Examination. Raw scores (cut-off: ≤ 18): AUC = .89; SE = .04; CI 95% [.80, .97]; adjusted scores (cut-off: < 19.015): AUC = .91; SE = .04; CI 95% [.84, .99]. MoCA scores were adjusted according to Aiello et al. [9]
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