The application of Mini-Mental State Examination and Montreal cognitive assessment for mild cognitive impairment and dementia in community survey

Objective To compare the accuracy,sensitivity,specificity of the Mini-Mental State Examination (MMSE) and Montreal cognitive assessment (MoCA) in screening of mild cognitive impairment(MCI) and dementia in community survey. Methods This study was conducted among residents aged 65 years and above in the urban and rural areas selected by stratified sampling from 6 urban and 2 rural communities.The 2 111 cases who finished the Neuropsychological tests included MMSE,MoCA,and Clinical Dementia Rating scale(CDR) were divided into groups normal control,MCI,and dementia.The accuracy,sensitivity and specificity was compared by the area under the curve (AUC) of receiver-operating characteristic curve.The clinical diagnoses of MCI was made according to Petersen′s criteria. Results The areas under curve were between 0.72 to 0.99 for MMSE and MoCA on discriminated MCI or dementia (Z=2.75，P 0.05). In MCI survey,the cutoff values and sensitivity/specificity of MMSE vs.MoCA in education levels of illiterate,primary,secondary and above were 21(84%/64%) vs.15(88%/54%),26(91%/70%) vs.20(94%/68%),27(93%/86%) vs.23(93%/80%) respectively;but in dementia survey,the cutoff values and sensitivity/specificity of MMSE vs. MoCA in education levels of illiterate,primary,secondary and above were 16(98%/85%) vs.11(98%/70%),20(100%/94%) vs.14(100%/87%),22(100%/98%) vs.16(100%/95%) respectively. Conclusions MMSE and MoCA are good cognitive assessment tools in the survey of MCI or dementia with high accuracy,sensitivity and specificity.But the cutoff value is different according to one′s education level.MoCA may be more suitable for MCI survey but MMSE for dementia. Key words: Cognition disorders; Dementia; Mini-Mental State Examination; Montreal cognitive assessment