대한치매학회지 (Dementia and Neurocognitive Disorders)

대한치매학회 (Korean Dementia Association)
권호 표지
DOI QR코드

DOI QR Code

Effect of Education on Discriminability of Montreal Cognitive Assessment Compared to Mini-Mental State Examination

  • Haeyoon Kim (Department of Psychology, College of Social Sciences, Hallym University) ;
  • Seonyeong Yang (Department of Psychology, College of Social Sciences, Hallym University) ;
  • Jaesel Park (Department of Psychology, College of Social Sciences, Hallym University) ;
  • Byeong Chae Kim (Department of Neurology, Choennam National University Hospital) ;
  • Kyung-Ho Yu (Department of Neurology, Hallym University Sacred Heart Hospital) ;
  • Yeonwook Kang (Department of Psychology, College of Social Sciences, Hallym University)
  • 투고 : 2023.04.03
  • 심사 : 2023.04.26
  • 발행 : 2023.04.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Purpose: The Montreal Cognitive Assessment (MoCA) has been known as a screening test for detecting mild cognitive impairment (MCI) better than Mini-Mental State Examination (MMSE). However, in previous domestic studies, no significant difference was found in the discriminability between MoCA and MMSE. Researchers have suggested that this might be because older Koreans are less educated than older Westerners. This study was conducted to examine the effect of education on the discriminability of MoCA compared to the MMSE. Methods: Participants were 123 cognitively normal elderly, 118 with vascular MCI, 108 with amnestic MCI, 121 with vascular dementia, and 113 with dementia of the Alzheimer's type. The Korean-MoCA (K-MoCA) and Korean-MMSE (K-MMSE) were administered. Multiple regression analyses and receiver operating characteristic (ROC) curve analyses were performed. Results: In all participants, education significantly affected both K-MoCA and K-MMSE scores along with age. The effect of education was re-examined by subgroup analysis after dividing subjects according to the level of education. Effect of education on K-MoCA and K-MMSE was only shown in the group with <9 years of education. ROC curve analyses revealed that the discriminability of K-MoCA to differentiate between vascular MCI and normal elderly was significantly higher than that of K-MMSE. When re-examining subgroups divided by education level, however, this higher discriminability of K-MoCA disappeared in the group with <9 years of education. Conclusions: These results indicate no difference in discriminating cognitive deficits between K-MoCA and K-MMSE in Korean elderly with <9 years of education.

키워드

참고문헌

  1. 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;53:695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
  2. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183-194. https://doi.org/10.1111/j.1365-2796.2004.01388.x
  3. 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;12:189-198. https://doi.org/10.1016/0022-3956(75)90026-6
  4. Folstein MF, Folstein SE, White T, Messer MA. MMSE-2 User's Manual. Lutz: Psychological Assessment Resources, 2010. 
  5. Ciesielska N, Sokolowski R, Mazur E, Podhorecka M, Polak-Szabela A, Kedziora-Kornatowska K. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol 2016;50:1039-1052. https://doi.org/10.12740/PP/45368
  6. Fujiwara Y, Suzuki H, Yasunaga M, Sugiyama M, Ijuin M, Sakuma N, et al. Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment. Geriatr Gerontol Int 2010;10:225-232. https://doi.org/10.1111/j.1447-0594.2010.00585.x
  7. Lu J, Li D, Li F, Zhou A, Wang F, Zuo X, et al. Montreal cognitive assessment in detecting cognitive impairment in Chinese elderly individuals: a population-based study. J Geriatr Psychiatry Neurol 2011;24:184-190. https://doi.org/10.1177/0891988711422528
  8. Pinto TC, Machado L, Bulgacov TM, Rodrigues-Junior AL, Costa ML, Ximenes RC, et al. Is the Montreal Cognitive Assessment (MoCA) screening superior to the Mini-Mental State Examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer's Disease (AD) in the elderly? Int Psychogeriatr 2019;31:491-504. https://doi.org/10.1017/S1041610218001370
  9. Roalf DR, Moberg PJ, Xie SX, Wolk DA, Moelter ST, Arnold SE. Comparative accuracies of two common screening instruments for classification of Alzheimer's disease, mild cognitive impairment, and healthy aging. Alzheimers Dement 2013;9:529-537. https://doi.org/10.1016/j.jalz.2012.10.001
  10. Pendlebury ST, Cuthbertson FC, Welch SJ, Mehta Z, Rothwell PM. Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: a population-based study. Stroke 2010;41:1290-1293. https://doi.org/10.1161/STROKEAHA.110.579888
  11. Wu Y, Wang M, Ren M, Xu W. The effects of educational background on Montreal Cognitive Assessment screening for vascular cognitive impairment, no dementia, caused by ischemic stroke. J Clin Neurosci 2013;20:1406-1410. https://doi.org/10.1016/j.jocn.2012.11.019
  12. Lee JY, Lee DW, Cho SJ, Na DL, Jeon HJ, 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;21:104-110. https://doi.org/10.1177/0891988708316855
  13. Kang YW, Park JS, Yu KH, Lee BC, et al. A reliability, validity, and normative study of the Korean-Montreal Cognitive Assessment (K-MoCA) as an instrument for screening of vascular cognitive impairment (VCI). Korean J Clin Psychol 2009;28:549-562. https://doi.org/10.15842/kjcp.2009.28.2.013
  14. Horton DK, Hynan LS, Lacritz LH, Rossetti HC, Weiner MF, Cullum CM. An abbreviated Montreal cognitive assessment (MoCA) for dementia screening. Clin Neuropsychol 2015;29:413-425. https://doi.org/10.1080/13854046.2015.1043349
  15. Malek-Ahmadi M, Powell JJ, Belden CM, O'Connor K, Evans L, Coon DW, et al. Age- and education-adjusted normative data for the Montreal Cognitive Assessment (MoCA) in older adults age 70-99. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2015;22:755-761. https://doi.org/10.1080/13825585.2015.1041449
  16. Kim JI, Sunwoo MK, Sohn YH, Lee PH, Hong JY. The MMSE and MoCA for screening cognitive impairment in less educated patients with Parkinson's disease. J Mov Disord 2016;9:152-159. https://doi.org/10.14802/jmd.16020
  17. Kim H, Yu KH, Lee BC, Kim BC, Kang Y. Validity of the Montreal Cognitive Assessment (MoCA) index scores: a comparison with the cognitive domain scores of the Seoul Neuropsychological Screening Battery (SNSB). Dement Neurocogn Disord 2021;20:28-37. https://doi.org/10.12779/dnd.2021.20.3.28
  18. Kwak HS, Kim SH. The normative study of the Montreal Cognitive Assessment-Korea (MoCA-K) as instrument for screening of mild cognitive impairment (MCI). J Korean Soc Integr Med 2021;9:37-45.
  19. Ministry of Health and Welfare. The Korean elderly survey [Internet]. Sejong: Ministry of Health and Welfare; 2020 [updated 2021 Jul 16; cited 2022 Aug 1]. Available from: https://www.narastat.kr/metasvc/index.do?confmNo=117071.
  20. Christensen KJ, Multhaup KS, Nordstrom S, Voss K. A cognitive battery for dementia: development and measurement characteristics. Psychol Assess 1991;3:168-174. https://doi.org/10.1037/1040-3590.3.2.168
  21. Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:2672-2713. https://doi.org/10.1161/STR.0b013e3182299496
  22. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR Jr, Kawas CH, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 2011;7:263-269. https://doi.org/10.1016/j.jalz.2011.03.005
  23. Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414. https://doi.org/10.1212/WNL.43.11.2412-a
  24. Kang Y. A normative study of the Korean-Mini Mental State Examination (K-MMSE) in the elderly. Korean J Psychol Gen 2006;25:1-12. 
  25. Kang Y, Jahng S, Na DL. Seoul Neuropsychological Screening Battery. Second Edition (SNSB-II): Professional Manual. Incheon: Human Brain Research and Consulting, 2012. 
  26. Cho MJ, Bae JN, Suh GH, Hahm BJ, Kim JK, Lee DW, et al. Validation of Geriatric Depression Scale, Korean Version (GDS) in the assessment of DSM-III-R major depression. J Korean Neuropsychiatr Assoc 1999;38:48-63. 
  27. Chin J, Park J, Yang SJ, Yeom J, Ahn Y, Baek MJ, et al. Re-standardization of the Korean-Instrumental Activities of Daily Living (K-IADL): clinical usefulness for various neurodegenerative diseases. Dement Neurocogn Disord 2018;17:11-22. https://doi.org/10.12779/dnd.2018.17.1.11
  28. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839-843. https://doi.org/10.1148/radiology.148.3.6878708
  29. Gorunescu F. Data Mining: Concepts, Models and Techniques. Berlin: Springer Science & Business Media, 2011;319-328. 
  30. Freitas S, Simoes MR, Alves L, Vicente M, Santana I. Montreal Cognitive Assessment (MoCA): validation study for vascular dementia. J Int Neuropsychol Soc 2012;18:1031-1040. https://doi.org/10.1017/S135561771200077X
  31. Matallana D, de Santacruz C, Cano C, Reyes P, Samper-Ternent R, Markides KS, et al. The relationship between education level and mini-mental state examination domains among older Mexican Americans. J Geriatr Psychiatry Neurol 2011;24:9-18. https://doi.org/10.1177/0891988710373597
  32. Wong A, Xiong YY, Kwan PW, Chan AY, Lam WW, Wang K, et al. The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dement Geriatr Cogn Disord 2009;28:81-87. https://doi.org/10.1159/000232589
  33. 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;57:304-308. https://doi.org/10.1111/j.1532-5415.2008.02096.x
  34. Ye BS, Seo SW, Cho H, Kim SY, Lee JS, Kim EJ, et al. Effects of education on the progression of early-versus late-stage mild cognitive impairment. Int Psychogeriatr 2013;25:597-606. https://doi.org/10.1017/S1041610212002001
  35. Wachholz TB, Yassuda MS. The interpretation of proverbs by elderly with high, medium and low educational level: abstract reasoning as an aspect of executive functions. Dement Neuropsychol 2011;5:31-37. https://doi.org/10.1590/S1980-57642011DN05010006
  36. Campanholo KR, Boa IN, Hodroj FC, Guerra GR, Miotto EC, de Lucia MC. Impact of sociodemographic variables on executive functions. Dement Neuropsychol 2017;11:62-68. https://doi.org/10.1590/1980-57642016dn11-010010
  37. Cortes Pascual A, Moyano Munoz N, Quilez Robres A. The relationship between executive functions and academic performance in primary education: review and meta-analysis. Front Psychol 2019;10:1582.
  38. De Jager CA, Hogervorst E, Combrinck M, Budge MM. Sensitivity and specificity of neuropsychological tests for mild cognitive impairment, vascular cognitive impairment and Alzheimer's disease. Psychol Med 2003;33:1039-1050. https://doi.org/10.1017/S0033291703008031
  39. Sachdev P, Kalaria R, O'Brien J, Skoog I, Alladi S, Black SE, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord 2014;28:206-218. https://doi.org/10.1097/WAD.0000000000000034
  40. Sudo FK, Amado P, Alves GS, Laks J, Engelhardt E. A continuum of executive function deficits in early subcortical vascular cognitive impairment: a systematic review and meta-analysis. Dement Neuropsychol 2017;11:371-380. https://doi.org/10.1590/1980-57642016dn11-040006
  41. Julayanont P, Tangwongchai S, Hemrungrojn S, Tunvirachaisakul C, Phanthumchinda K, Hongsawat J, et al. The Montreal Cognitive Assessment-Basic: a screening tool for mild cognitive impairment in illiterate and low-educated elderly adults. J Am Geriatr Soc 2015;63:2550-2554. https://doi.org/10.1111/jgs.13820
  42. Luis CA, Keegan AP, Mullan M. Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry 2009;24:197-201. https://doi.org/10.1002/gps.2101