There are several features in MoCA’s design that likely explain its superior sensitivity for detecting MCI. MoCA is also sensitive to detect cognitive impairment in cerebrovascular disease and Parkinson’s disease, Huntington’s disease, brain tumors, systemic lupus erythematosus, substance use disorders, idiopathic rapid eye movement sleep behavior disorder, obstructive sleep apnea, risk of falling, rehabilitation outcome, epilepsy, chronic obstructive pulmonary disease and human immunodeficiency virus infection. MoCA’s sensitivity and specificity to detect subjects with MCI due to Alzheimer’s disease and distinguish them from healthy controls are excellent. Its validity has been established to detect mild cognitive impairment in patients with Alzheimer’s disease and other pathologies in cognitively impaired subjects who scored in the normal range on the MMSE. It is a simple 10 min paper and pencil test that assesses multiple cognitive domains including memory, language, executive functions, visuospatial skills, calculation, abstraction, attention, concentration, and orientation. Findings of these studies have implications for current cognitive screening procedures and techniques used to develop these tools.The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument developed to detect mild cognitive impairment (MCI). Results revealed that the addition of measures of processing speed, category fluency, and verbal recall resulted in an Expanded SF-MoCA with diagnostic classification accuracy superior to both the standard MoCA and SF-MoCA. Therefore, we conducted a second study to determine if diagnostic accuracy of the SF-MoCA might be enhanced through the addition of several brief and well-validated neuropsychological measures shown to be sensitive to cognitive impairment. Despite the advantages of the SF-MoCA, this tool only assesses three cognitive domains and may not be appropriate in settings where clinicians may want to efficiently assess additional domains affected in AD and MCI to gain a clearer picture of global functioning and assist in differential diagnosis. Given the brevity and sensitivity of the SF-MoCA, we suggested this measure may be useful for early detection of cognitive impairment in primary care and other settings where evaluation time is limited. Overall, diagnostic accuracy of the SF-MoCA was superior to the MMSE and comparable to the standard MoCA, suggesting that some MoCA items do not add to the sensitivity of the instrument in these populations. Results revealed delayed recall, orientation, and serial subtraction items to be most useful in differentiating the diagnostic groups. The aim of Study 1 was to create a short form of the MoCA (SF-MoCA) including only the items found to be most sensitive to MCI and Alzheimer disease (AD) and compare the diagnostic classification accuracy of the SF-MoCA to the Mini-Mental State Examination (MMSE) and standard MoCA. We devised two studies to address common limitations of cognitive screening tools using the MoCA. The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument growing in popularity which has demonstrated increased sensitivity to mild cognitive impairment (MCI), but takes roughly 10-15 minutes to administer and was developed without an empirically-driven item selection process. However, popular cognitive screening tools have been criticized for their insensitivity to subtle cognitive impairment, poor specificity, excessive administration time, and/or questionable methods of test development. Cognitive screening is becoming increasingly important as the general population ages and the prevalence of dementia rises.
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