MoCA, ACE-R and MMSE versus the NINDS-CSN VCI Harmonisation Standards Neuropsychological Battery after TIA and stroke

Abstract

Background

The Montreal Cognitive Assessment (MoCA) and Addenbrooke’s cognitive examination-revised (ACE-R) are proposed as short cognitive tests for use after stroke but there are few published validations against neuropsychological battery. We studied MoCA, ACE-R and mini-mental-state-examination(MMSE) in patients with cerebrovascular disease and mild cognitive impairment (MCI)

Methods

100 consecutive patients had the MMSE, MoCA, ACE-R and NINDS-CSN VCI Harmonisation Standards Neuropsychological Battery ≥1 year after TIA or stroke in a population-based study. MCI was diagnosed using modified Petersen criteria in which subjective cognitive complaint is not required (equivalent to cognitive- impairment-no-dementia (CIND)) and sub-typed by number and type of cognitive domains affected.

Results

Among 91 non-demented subjects completing neuropsychological testing (mean/sd age 73.4/11.6 years, 44% female, 56% stroke), 39 (42%) had MCI (amnestic multiple domain=10, non-amnestic multiple domain=9, non-amnestic single domain=19, amnestic single domain=1). Sensitivity and specificity for MCI were optimal with MoCA<25 (sensitivity=77%, specificity=83%) and ACE-R<94 (sensitivity=83%, specificity=73%). Both tests detected amnestic MCI better than non-amnestic single domain impairment. MMSE only achieved sensitivity>70% at a cut-off of<29, mainly due to relative insensitivity to single domain impairment.

Conclusion

The MoCA and ACE-R had good sensitivity and specificity for MCI defined using the NINDS-CSN VCI Battery ≥1 year after TIA and stroke whereas the MMSE showed a ceiling effect. However, optimal cut-offs will depend on use for screening (high sensitivity) or diagnosis (high specificity). Lack of timed measures of processing speed may explain the relative insensitivity of the MoCA and ACE-R to single non-memory domain impairment.