Validity of the Montreal Cognitive Assessment in the Detection of Mild Cognitive Impairment in Parkinson’s Disease

Authors: O. Bezdíček 1;  J. Michalec 2;  T. Nikolai 1;  H. Štěpánková 3;  E. Panenková 3;  P. Harsa 2;  P. Havránková 1;  J. Roth 1;  M. Kopeček 3,4;  E. Růžička 1
Authors‘ workplace: Neurologická klinika a Centrum klinických neurověd, 1. LF UK a VFN v Praze 1;  Psychiatrická klinika 1. LF UK a VFN v Praze 2;  Psychiatrické centrum Praha 3;  Klinika psychiatrie 3. LF UK v Praze 4
Published in: Cesk Slov Neurol N 2014; 77/110(1): 47-53
Category: Original Paper


To establish psychometric properties of the Montreal Cognitive Assessment (MoCA) with respect to detecting mild cognitive impairment in Parkinson’s disease (PD-MCI).

MCI is considered a transitional stage between normal cognitive functioning and dementia. The MoCA has recently been recommended as one of the standard tools for the diagnosis of PD-MCI. However, its detection potential in the Czech population has not been demonstrated.

A sample of 80 patients with PD was administered the MoCA and a neuropsychological battery with criteria operationalized for MCI-deficits. Thirty nine of these patients (PD-MCI sample) were age and education-matched to a control sample (CS). ROC analysis was used to ascertain classification statistics (discriminative validity) of the MoCA as a diagnostic instrument.

The MoCA total score was significantly different between PD-MCI and CS (p = 0.006). Delayed recall was the most differentiating MoCA subscore (p < 0.001). The 28/29 scores were identified as an optimal screening MoCA cut-off to discriminate PD-MCI from CS was (sensitivity = 0.90, specificity = 0.32; positive and negative predictive value = 0.57 and 0.76, respectively). We constructed a regression equation based on a large control sample of the Czech population (n = 268) to estimate the MoCA’s age and education-specific performance more accurately.

Despite the group differences between PD-MCI and CS, our results show that MoCA has an unsatisfactory detection potential for an individual diagnosis of PD-MCI. A comprehensive neuropsychological battery is thus recommendable.

Key words:
validity – mild cognitive impairment – diagnostic criteria – Parkinson’s disease – Montreal Cognitive Assessment

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Litvan I, Goldman JG, Tröster AI, Schmand BA, Weintraub D, Petersen RC et al. Diagnostic criteria for mild cognitive impairment in Parkinson’s disease: Movement Disorder Society Task Force guidelines. Mov Disord 2012; 27(3): 349–356.

2. 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.

3. Litvan I, Aarsland D, Adler CH, Goldman JG, Kulisevsky J, Mollenhauer B et al. MDS Task Force on mild cognitive impairment in Parkinson’s disease: critical review of PD-MCI. Mov Disord 2011; 26(10): 1814–1824.

4. Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG. The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord 2008; 23(6): 837–844.

5. Aarsland D, Tandberg E, Larsen JP, Cummings JL. Frequency of dementia in Parkinson disease. Arch Neurol 1996; 53(6): 538–542.

6. 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.

7. 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.

8. Nasreddine ZS, Phillips NA, Bédirian 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.

9. Bezdíček O, Balabánová P, Havránková P, Roth J, Růžička E. Srovnání české verze Montrealského kognitivního testu s Mini-Mental State pro stanovení kognitivního deficitu u Parkinsonovy nemoci. Cesk Slov Neurol N 2010; 73/106(2): 150–156.

10. Bezdicek O, Majerova V, Novak M, Nikolai T, Ruzicka E, Roth J. Validity of the Montreal Cognitive Assessment in the detection of cognitive dysfunction in Huntington’s disease. Appl Neuropsychol Adult 2013; 20(1): 33–40.

11. 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.

12. Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 2010; 25(15): 2649–2653.

13. Bezdíček O, Lukavský J, Preiss M. Validizační studie české verze dotazníku FAQ. Cesk Slov Neurol N 2011; 74/107(1): 36–42.

14. Fagan TJ. Letter: Nomogram for Bayes theorem. N Engl J Med 1975; 293(5): 257.

15. Kasten M, Bruggemann N, Schmidt A, Klein C. Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology 2010; 75(5): 478.

16. Pillon B, Boller F, Levym R, Dubois B. Cognitive deficits and dementia in Parkinson’s disease. In: Boller F, Cappa SF (eds). Handbook of neuropsychology. Aging and dementia. 2nd ed. Amsterdam: Elsevier 2001: 311–371.

17. 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.

18. Rossetti HC, Lacritz LH, Cullum CM, Weiner MF. Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample. Neurology 2011; 77(13): 1272–1275.

19. Crawford JR, Howell DC. Regression equations in clinical neuropsychology: an evaluation of statistical methods for comparing predicted and obtained scores. J Clin Exp Neuropsychol 1998; 20(5): 755–762.

20. Urbánek T, Denglerová D, Širůček J. Psychometrika. Měření v psychologii. Praha: Portál 2011.

21. Mitrushina M, Boone KB, Razani J, D’Elia LF. Handbook of Normative Data for Neuropsychological Assessment. 2nd ed. New York: Oxford University Press 2005.

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