Cut-off points of the Portuguese version of the Montreal Cognitive Assessment for cognitive evaluation in Parkinson’s disease

Abstract

ABSTRACT. The Movement Disorder Society has published some recommendations for dementia diagnosis in Parkinson disease (PD), proposing the Montreal Cognitive Assessment (MOCA) as a cognitive screening tool in these patients. However, few studies have been conducted assessing the Portuguese version of this test in Brazil (MOCA-BR). Objective: the aim of the present study was to define the cut-off points of the MOCA-BR scale for diagnosing Mild Cognitive Impairment (PD-MCI) and Dementia (PD-D) in patients with PD. Methods: this was a cross-sectional, analytic field study based on a quantitative approach. Patients were selected after a consecutive assessment by a neurologist, after an extensive cognitive evaluation, and were classified as having normal cognition (PD-N), PD-MCI or PD-D. The MOCA-BR was then applied and 89 patients selected. Results: on the cognitive assessment, 30.3% were PD-N, 41.6% PD-MCI and 28.1% PD-D. The cut-off score on the MOCA-Br to distinguish PD-N from PD-D was 22.50 (95% CI 0.748-0.943) for sensitivity of 85.5% and specificity of 71.1%. The cut-off for distinguishing PD-D from MCI was 17.50 (95% CI 0.758-0.951) for sensitivity of 81.6% and specificity of 76%.

Diagnóstico e manejo da demência da doença de Parkinson e demência com corpos de Lewy: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

“…Studies with Brazilian PD patients have used several instruments to assess functional abilities, including the Pfeffer Functional Activities Questionnaire (FAQ), the Disability Assessment for Dementia (DAD), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Pill questionnaire, the phone call test, and the Direct Assessment of Functional Abilities (DAFA) ( 15 ),( 33 )-( 37 . Two studies evaluated the PFAQ accuracy to detect functional impairment in patients with PD 33 ),( 37 . Oliveira et al proposed that a score >2 had 23% sensitivity and 74% specificity to predict abnormal performance on a global cognitive test 33 .…”

“…Corroborando com esses dados, dois estudos brasileiros sugeriram que o questionário da pílula é menos sensível do que outros instrumentos para detectar comprometimento funcional 15,33 . Estudos prévios avaliando pacientes brasileiros com DDP utilizaram alguns instrumentos para avaliar habilidades funcionais, incluindo o questionário de atividades funcionais de Pfeffer, Avaliação de Incapacidade em Demência (DAD), Questionário de Informante sobre Declínio Cognitivo em Idosos (IQCODE), Pill Questionnaire, teste de telefone e Avaliação Direta da Capacidade Funcional (DAFA) 15,[33][34][35][36][37] . Dois estudos avaliaram a precisão do Pfeffer para detectar comprometimento funcional em pacientes com DP 33,37 .…”

“…O Montreal Cognitive Assessment (MoCA) e a escala cognitiva de Addenbrooke-revisada (ACE-R) são outros instrumentos cognitivos globais breves que foram utilizados para avaliar a cognição em DP e DCL, ambos já traduzidos e validados em coortes brasileiras [40][41][42] . Estudos prévios sugeriram que eles podem ser mais eficazes do que o MEEM para detectar demência em pacientes com DP 35,36,38,43,44 . No entanto, a maioria dos estudos não demonstrou a precisão adequada para avaliar CCL por DP 43 .…”

Diagnosis and management of Parkinson’s disease dementia and dementia with Lewy bodies: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

“…Accordingly, two Brazilian studies suggested that the pill questionnaire was less sensitive than other instruments to detect functional impairment 15,33 . Studies with Brazilian PD patients have used several instruments to assess functional abilities, including the Pfeffer Functional Activities Questionnaire (FAQ), the Disability Assessment for Dementia (DAD), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Pill questionnaire, the phone call test, and the Direct Assessment of Functional Abilities (DAFA) 15,[33][34][35][36][37] . Two studies evaluated the PFAQ accuracy to detect functional impairment in patients with PD 33,37 .…”

“…They have already been translated and validated for Brazilian populations [40][41][42] . Some studies suggest that these instruments may be more effective than the MMSE to detect dementia in PD patients 35,36,38,43,44 . However, most studies showed inadequate accuracy to evaluate PD-MCI 43 .…”