Screening for Cognitive Impairment in Movement Disorders: Comparison of the Montreal Cognitive Assessment and Quick Mild Cognitive Impairment Screen in Parkinson's Disease and Lewy Body Dementia

Abstract

Background: The Montreal Cognitive Assessment (MoCA) is recommended by the Movement Disorder Society for cognitive testing in movement disorders including Parkinson's disease (PD) and lewy body dementia. Few studies have compared cognitive screening instruments in these diseases, which overlap clinically.

Objective: To compare the MoCA and Quick Mild Cognitive Impairment (Qmci) screen in this population.

Methods: Patients attending memory and movement disorder clinics associated with a university hospital had the MoCA and Qmci screen performed and diagnostic accuracy compared with the area under the receiver operating characteristic curve (AUC). Duration and severity of movement disorders was assessed using the Unified PD Rating Scale (UPDRS).

Results: In total, 133 assessments were available, median age 74±5. Median education was 11±4 years and 65% were male. Median total UPDRS score was 37±26. Median Qmci screen was 51±27, median MoCA was 19±10. There were statistically significant differences in test scores between those with subjective symptoms but normal cognition, mild cognitive impairment (MCI) and dementia (p < 0.001). The Qmci screen had significantly greater accuracy differentiating normal cognition from MCI versus the MoCA (AUC 0.90 versus 0.72, p = 0.01). Both instruments had similar accuracy in identifying cognitive impairment and separating MCI from dementia. The median administration time for the Qmci screen and MoCA were 5.19 and 9.24 minutes (p < 0.001), respectively.

Conclusions: Both the MoCA and Qmci screen have good to excellent accuracy in a population with movement disorders experiencing cognitive symptoms. The Qmci screen was significantly more accurate for those with early symptoms and had a shorter administration time.

Keywords: Alzheimer’s disease; Montreal Cognitive Assessment; Parkinson’s disease; cognitive assessment screening instrument; lewy body disease; movement disorders.

Fig. 1

Receiver Operating Characteristic curves demonstrating the accuracy of the Quick Mild Cognitive Impairment (Qmci) screen and Montreal Cognitive Assessment (MoCA) in differentiating patients with movement disorders experiencing cognitive symptoms (Parkinson’s disease and Lewy Body Dementia) in separating (a) mild cognitive impairment (MCI) from normal cognition, (b) MCI and dementia, (c) normal from cognitive impairment (MCI and dementia), (d) Dementia from everything else.