Comparison of the use of screening tools for evaluating cognitive impairment in patients with Parkinson's disease

Abstract

BackgroundScreening tests have been used for cognitive deficits in Parkinson's disease (PD).ObjectiveThis study compared the Montreal Cognitive Assessment (MoCA) test, the Mini-Mental State Examination (MMSE) and the clock drawing test for this purpose.MethodsA total of 50 patients with PD were selected, 41 (82%) were diagnosed with dementia by the criteria of the Movement Disorder Society. The test Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog) was used as the gold standard in comparison with the screening tests.ResultsThe MoCA test (AUC=0.906) had a sensitivity of 87.80% and specificity of 88.89%. When the MMSE was associated with the clock drawing test (AUC=0.936), it had a specificity of 66.67% and sensitivity of up to 97.56%.ConclusionThe study suggests that the MoCA test can be a good screening test in PD. However, MMSE associated with the clock drawing test may be more effective than the MoCA test.

Montreal Cognitive Assessment scale in patients with Parkinson Disease with normal scores in the Mini-Mental State Examination

“…It is noteworthy that average scores on the Clock Drawing Test were lower than normal, correlating with alterations on the visuospatial/executive section of the MoCA; data to be considered as a way of compensating for the deficiencies of the MMSE in the evaluation of patients with PD. 17 - 19 The present study corroborates the facts documented by many other investigations, showing that the MoCA can detect the presence of cognitive deterioration in patients with PD. This is of paramount importance because the presence of MCI represents a risk factor for subsequent development of dementia and instruments such as the MMSE lack the sensitivity and specificity to detect the condition.…”

“…On the other hand, the comparison of the different cognitive areas showed that visuospatial, attention and delayed recall functions were the most relevant, a result in line with other investigations. 16 , 17 These findings suggest that initial cognitive impairment in PD patients occurs in a range of cognitive domains and highlights the importance of a thorough cognitive assessment using a simple but sensitive neuropsychological test. It is noteworthy that average scores on the Clock Drawing Test were lower than normal, correlating with alterations on the visuospatial/executive section of the MoCA; data to be considered as a way of compensating for the deficiencies of the MMSE in the evaluation of patients with PD.…”

Performance at the clock drawing test of individuals affected by Parkinson’s disease and healthy subjects: a retrospective study

“…According to Stella and colleagues [14], PD patients showed difficulties in visuospatial organization and visuoconstructive skills in CDT; instead, Saur and colleagues [15] suggested that the patients' poorly performance, characterized specifically by errors in planning of numbers and hands position as well as by the use of postmeridian digits, might suggest more prominent executive deficits rather than visuospatial impairments. In a successive study by Camargo and colleagues [3], PD patients with and without a diagnosis of dementia showed a different performance in CDT. Interestingly, the authors reported that when CDT was used together with MMSE, the level of sensitivity in distinguishing between the two groups increased respect to MMSE alone.…”

“…Clock Drawing Test (CDT) [1] is a common, quick and easy-to-apply neuropsychological instrument to assess global cognitive functioning. Indeed, multiple cognitive domains, including language comprehension, numerical knowledge, executive functions, attention, visuospatial abilities and verbal short-term memory [2][3], are implied to solve it. Because of its usefulness in detecting comprehensively significant information about individuals' cognitive functioning, CDT is frequently used by geriatric experts [4] in clinical settings.…”

“…Previous -but not conclusive -evidence about the CDT applicability as a screening tool in PD was reported in literature [3,9,14,15]. According to Stella and colleagues [14], PD patients showed difficulties in visuospatial organization and visuoconstructive skills in CDT; instead, Saur and colleagues [15] suggested that the patients' poorly performance, characterized specifically by errors in planning of numbers and hands position as well as by the use of postmeridian digits, might suggest more prominent executive deficits rather than visuospatial impairments.…”