A Comparison of the Czech Version of the Montreal Cognitive Assessment Test with the Mini Mental State Examination in Identifying Cognitive Deficits in Parkinson’s Disease

Authors: O. Bezdíček;  P. Balabánová;  P. Havránková;  J. Štochl;  J. Roth;  E. Růžička
Authors‘ workplace: Neurologická klinika 1. LF UK a VFN v Praze
Published in: Cesk Slov Neurol N 2010; 73/106(2): 150-156
Category: Original Paper


Comparison of two brief screening tests for the detection of cognitive deficits in Parkinson’s disease.

The Montreal Cognitive Assessment (MoCA) was developed as a screening tool for the identification of cognitive deficits in Alzheimer’s disease and its use has been proposed in Parkinson’s disease (PD). Cognitive deficit is common in PD and its early detection improves the prospects for medical intervention. The Czech version of MoCA is freely available, but its validity has not yet been demonstrated. We therefore compared the sensitivity of MoCA with that of the mini mental state examination (MMSE), currently the representative screening test for the detection of cognitive deficit. Unlike MMSE, MoCA contains subtests of executive functions and sustained attention as well employing more extensive tasks in naming and word recall.

MMS and MoCA were administered in alternating order to 81 randomly selected PD patients and to 34 age‑matched normal controls (NC).

Total raw scores of MoCA and MMS differed significantly between NC and PD. The total score for MoCA significantly differed from MMSE (p <0.0005) in PD as well as in NC (p <0.0005). Using the same cut‑off score of less than 26, in the PD patient subgroup MoCA detected cognitive deficit in 74.1% of patients as against 38.3% judging by MMSE. In comparison to NC, about twice as many PD patients failed in executive functions subtests, which are not covered by MMSE. PD patients also failed more frequently than NC in the “naming subscale” (20 vs 3%) and “attention subscale” (41 vs 6%) of MoCA. Test‑retest reliability of MoCA was 0.82, internal consistency (split‑half) was 0.69, Cronbach’s α = 0.72. Convergent validity between MoCA and MMSE was 0.73. The administration time of MoCA was approximately two times longer than that for MMSE (ca. 10 vs 5 min, p < 0.005).

Our results indicate that MoCA may be a more efficient indicator of cognitive deficit than MMSE in PD, especially in executive functions, naming and attention. The Czech version of MoCA has shown good psychometric properties, comparable to those reported in previous studies. It can henceforth be viewed as an appropriate screening test of cognitive deficit in PD.

Key words:
cognitive impairment – Parkinson’s disease – Mini-Mental State Examination – Montreal Cognitive Assessment – neuropsychology


1. Foltynie T, Brayne CE, Robbins TW, Barker RA. The cognitive ability of an incident cohort of Parkinson’s patients in the UK. The CamPaIGN study. Brain 2004; 127(3): 550–560.

2. Muslimovic D, Post B, Speelman JD, Schmand B. Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology 2005; 65(8): 1239–1245.

3. Riedel O, Klotsche J, Spottke A, Deuschl G, Förstl H,Henn F et al. Cognitive impairment in 873 patients with idiopathic Parkinson’s disease. Results from the German Study on Epidemiology of Parkinson’s Disease with Dementia (GEPAD). J Neurol 2008; 255(2): 255–264.

4. Aarsland D, Brønnick K, Larsen JP, Tysnes OB, Alves G; Norwegian ParkWest Study Group. Cognitive impairment in incident, untreated Parkinson disease: the Norwegian ParkWest study. Neurology 2009; 72(13): 1121–1126.

5. Aarsland D, Andersen K, Larsen JP, Lolk A, Kragh‑-Sørensen P. Prevalence and characteristics of dementia in Parkinson disease: an 8‑year prospective study. Arch Neurol 2003; 60(3): 387–392.

6. Sutcliffe RL, Meara JR. Parkinson’s disease epidemiology in the Northampton District, England, 1992. Acta Neurol Scand 1995; 92(6): 443–450.

7. Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C,Mizuno Y et al. Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Mov Disord 2007; 22(12): 1689–1707.

8. Marder K, Leung D, Tang M, Bell K, Dooneief G, Cote L et al. Are demented patients with Parkinson’s disease accurately reflected in prevalence surveys? A survival analysis. Neurology 1991; 41(8): 1240–1243.

9. Aarsland D, Larsen JP, Karlsen K, Lim NG, Tand­berg E. Mental symptoms in Parkinson’s disease are important contributors to caregiver distress. Int J Geriatr Psychiatry 1999; 14(10): 866–874.

10. Holroyd S, Currie L, Wooten GF. Prospective study of hallucinations and delusions in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2001; 70(6): 734–738.

11. Dubois B. Is PD‑MCI a useful concept? Mov Disord 2007; 22(9): 1215–1216.

12. Janvin CC, Larsen JP, Aarsland D, Hugdahl K. Subtypes of mild cognitive impairment in Parkinson’s disease: progression to dementia. Mov Disord 2006; 21(9): 1343–1349.

13. Caviness JN, Driver‑Dunckley E, Connor DJ, Sabbagh MN, Hentz JG, Noble B et al. Defining mild cognitive impairment in Parkinson’s disease. Mov Disord 2007; 22(9): 1272–1277.

14. Folstein MF, Folstein SE, McHugh PR. “Mini‑mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189–198.

15. Folstein MF, Folstein SE, McHugh PR. Mini‑Mental® State Examination (MMSE™). Lutz: Psychological Assessment Resources 2000.

16. Gill DJ, Freshman A, Blender JA, Ravina B. The Montreal cognitive assessment as a screening tool for cognitive impairment in Parkinson’s disease. Mov Disord 2008; 23(7): 1043–1046.

17. Zadikoff C, Fox SH, Tang‑Wai DF, Thomsen T, de Bie RM, Wadia P et al. A comparison of the Mini mental state exam to the Montreal cognitive assessment in identifying cognitive deficits in Parkinson’s disease. Mov Disord 2008; 23(2): 297–299.

18. Kulisevsky J, Pagonabarraga J. Cognitive impairment in Parkinson’s disease: tools for diagnosis and Assessment. Mov Disord 2009; 24(8): 1103–1110.

19. Hummelová‑Fanfrdlová Z, Rektorová R, Sheardová K, Bartoš A, Línek V, Ressner P et al. Česká adaptace Addenbrookského kognitivního testu. Cesk psychol 2009; 53(4): 376–388.

20. Topinková E, Jirák R, Kožený J. Neurokognitivní baterie pro screening demence v klinické praxi: Sedmiminutový screeningový test. Neurol pro praxi 2002; 3(6): 323–328.

21. Robben SH, Sleegers MJ, Dautzenberg PL, van Bergen FS, Ter Bruggen JP, Rikkert MG. Pilot study of a three‑step diagnostic pathway for young and old patients with Parkinson’s disease dementia: screen, test and then diagnose. Int J Geriatr Psychiatry 2010; 25(3): 258–265.

22. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53(4): 695–699.

23. Nazem S, Siderowf AD, Duda JE, Have TT, Colcher A, Horn SS et al. Montreal cognitive assessment performance in patients with Parkinson’s disease with “normal” global cognition according to mini‑mental state examination score. J Am Geriatr Soc 2009; 57(2): 304–308.

24. Montrealský kognitivní test. 2010. Dostupné z URL: http://www.mocatest.org/pdf_files/MoCA‑Test‑Czech.pdf.

25. Rektorová, I. Neurodegenerativní demence. Cesk Slov Neurol N 2009; 72/105(2): 97–109.

26. Mahieux F, Fénelon G, Flahault A, Manifacier MJ, Michelet D, Boller F. Neuropsychological prediction of dementia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1998; 64(2): 178–183.

27. Lewis SJ, Dove A, Robbins TW, Barker RA, Owen AM. Cognitive impairments in early Parkinson’s disease are accompanied by reductions in activity in frontostriatal neural circuitry. J Neurosci 2003; 23(15): 6351–6356.

28. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico‑pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992; 55(3): 181–184.

29. Sheik JI, Yesavage JA, Geriatric Depression Scale. Recent Evidence and Development of a Shorter Version. In: Brink TL, Editor. Clinical gerontology: a guide to assessment and intervention. New York: Howarth Press 1986: 165–173.

30. Statistical Package for the Social Sciences 16.0 SPSS Inc. Chicago, Illinois 2007.

31. Lezak MD, Howieson DB, Loring DW, Hannay HJ, Fischer JS. Neuropsychological Assessment. 4th ed. New York: Oxford University Press 2004.

32. Glatt SL, Hubble JP, Lyons K, Paolo A, Tröster AI, Hassanein RE et al. Risk factors for dementia in Parkinson’s disease: effect of education. Neuroepidemiology 1996;15(1): 20–25.

33. Beach TG, Adler CH, Lue L, Sue LI, Bachalakuri J, Henry‑Watson J et al. Unified staging system for Lewy body disorders: correlation with nigrostriatal degeneration, cognitive impairment and motor dysfunction. Acta Neuropathol 2009; 117(6): 613–634.

34. Zakzanis KK, Leach L, Kaplan E. On the nature and pattern of neurocognitive function in major depressive disorder. Neuropsychiatry Neuropsychol Behav Neurol 1998; 11(3): 111–119.

35. Cubo E, Bernard B, Leurgans S, Raman R. Cognitive and motor function in patients with Parkinson’s disease with and without depression. Clin Neuropharmacol 2000; 23(6): 331–334.

36. Kafonek S, Ettinger WH, Roca R, Kittner S, Taylor N,German PS. Instruments for screening for depression and dementia in a long‑term care facility. J Am Geriatr Soc 1989; 37(1): 29–34.

37. Schrag A, Barone P, Brown RG, Leentjens AFG, McDonald WM, Starkstein S et al. Depression rating scales in Parkinson’s disease: critique and recommendations. Mov Disord 2007; 22(8): 1077–1092.

38. Lee JY, Dong Woo Lee, Cho SJ, Na DL, Hong Jin Jeon, Kim SK et al. Brief screening for mild cognitive impairment in elderly outpatient clinic: validation of the korean version of the montreal cognitive assessment. J Geriatr Psychiatry Neurol 2008; 21(2): 104–110.

39. Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB et al. Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology 2009; 73(21): 1738–1745.

40. Dubois B, Burn D, Goetz C, Aarsland D, Brown RG, Broe GA et al. Diagnostic procedures for Parkinson’s disease dementia: recommendations from the movement disorder society task force. Mov Disord 2007; 22(16): 2314–2324.

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