Use of the Montreal Cognitive Assessment Thai Version to Discriminate Amnestic Mild Cognitive Impairment from Alzheimer’s Disease and Healthy Controls: Machine Learning Results

Abstract

<b><i>Background:</i></b> The Montreal Cognitive Assessment (MoCA) is an effective and applicable screening instrument to confirm the diagnosis of amnestic mild cognitive impairment (aMCI) from patients with Alzheimer’s disease (AD) and healthy controls (HCs). <b><i>Objectives:</i></b> This study aimed to determine the reliability and validity of the following: (a) Thai translation of the MoCA (MoCA-Thai) and (b) delineate the key features of aMCI based on the MoCA subdomains. <b><i>Methods:</i></b> This study included 60 HCs, 61 aMCI patients, and 60 AD patients. The MoCA-Thai shows adequate psychometric properties including internal consistency, concurrent validity, test-retest validity, and inter-rater reliability. <b><i>Results:</i></b> The MoCA-Thai may be employed as a diagnostic criterion to make the diagnosis of aMCI, whereby aMCI patients are discriminated from HC with an area under the receiver-operating characteristic (AUC-ROC) curve of 0.813 and from AD patients with an AUC-ROC curve of 0.938. The best cutoff scores of the MoCA-Thai to discriminate aMCI from HC is ≤24 and from AD > 16. Neural network analysis showed that (a) aberrations in recall was the most important feature of aMCI versus HC with impairments in language and orientation being the second and third most important features and (b) aberrations in visuospatial skills and executive functions were the most important features of AD versus aMCI and that impairments in recall, language, and orientation but not attention, concentration, and working memory, further discriminated AD from aMCI. <b><i>Conclusions:</i></b> The MoCA-Thai is an appropriate cognitive assessment tool to be used in the Thai population for the diagnosis of aMCI and AD.

Construction of a short version of the Montreal Cognitive Assessment (MoCA) rating scale using Partial Least Squares analysis

“…Data from our previous study (Hemrungrojn et al ., 2021) was utilized in this analysis. Of the total 181 participants, 60 were healthy controls (HC), 61 were individuals with aMCI, and 60 were AD patients from King Chulalongkorn Memorial Hospital, Chao Phraya Abhaibhubejhr Hospital, and Angthong Hospital, Thailand.…”

“…Construct validity measures whether the tool in question is strongly associated with other similar cognitive tests, whilst internal consistency measures whether the items that make up the tool in question are closely related. The MoCA has generally demonstrated good construct validity (average variance extracted, AVE, of 0.46 – 0.75) (Freitas, Simões, Marôco, et al ., 2012) and good internal consistency (Cronbach’s alpha = 0.83 - 0.903) for MCI and AD patients (Nasreddine et al ., 2005; Freitas, Simões, Marôco, et al ., 2012; Hemrungrojn et al ., 2021). These measures have also been reported to be good, however lower, in other populations such as healthy older adults and those with major depressive disorder (Cronbach’s alpha = 0.60 - 0.64) (Cooley et al ., 2015; Srisurapanont et al ., 2017).…”

“…The MoCA is a 10-minute test for older adults that evaluates cognitive domains such as executive function, visuospatial function, memory, language, orientation, and attention. Since its appearance, many validation studies continuously report that the MoCA (English version and other language versions) had good diagnostic accuracy in discriminating MCI and AD patients, and better psychometric properties compared to other cognitive impairment tests (Fujiwara et al ., 2010; Freitas, Simões, Alves, et al ., 2012; Freitas et al ., 2013; Azdad et al ., 2019; Freud et al ., 2020; Serrano et al ., 2020; Hemrungrojn et al ., 2021).…”

“…translated and validated Thai version of the MoCA (MoCA-Thai) was used(Hemrungrojn et al, 2021). The items of the test are divided into 7 subdomains:(1) Visuospatial/Executive (modified trail-making B task: 1 point, clock drawing: 3 points, and cube copying: 1 point), (2) Naming (lion, rhinoceros, and camel: 3 points), (3) Attention (digit forward and backward: 2 points, target detection using tapping: 1 point, and serial subtraction: 3 points), (4) Language (sentence repetition: 2 points, and phonemic fluency: 1 point), (5) Abstraction (2item verbal abstraction: 2 points), (6) Delayed Recall (recall of 5 nouns after 5 minutes: 5 points), and (7) Orientation (orientation to time and place: 6 points).…”

Oxidative stress and antioxidant defenses in mild cognitive impairment: a systematic review and meta-analysis

“…Cognitive impairment often occurs with a prevalence of 10%-15% in elderly individuals aged over 65 years (Anderson, 2019). Amnestic Mild Cognitive Impairment (aMCI) is defined by milder deficits in neurocognitive functions, most notably episodic memory, language difficulties, poor learning ability, and problem solving, but without functional decline in basic activities of daily living (ADL) (Hemrungrojn et al, 2021;Petersen et al, 2010). The conversion rate from aMCI to Alzheimer's disease is approximately 16.5 percent per year, but some patients (8%) with aMCI may revert to a normal state, indicating that some, but not all, aMCI patients are at increased risk of developing dementia (Petersen et al, 2010).…”