We recruited 52 patients with multiple sclerosis (61.5% women mean age : 41.7 years). We aimed to evaluate the diagnostic validity and reliability of the Montreal Cognitive Assessment (MoCA) test as a screening tool for CI in patients with multiple sclerosis, as compared against the Brief Neuropsychological Battery. Simpler tests are needed to detect cognitive impairment in daily clinical practice. doi:10.1111/jgs.The neuropsychological batteries traditionally used for the assessment of cognitive impairment (CI) in patients with multiple sclerosis are complex tests requiring a long time to administer. Is the Montreal Cognitive Assessment culturally valid in a diverse geriatric primary care setting? lessons from the Bronx. Stimmel MB, Orkaby AR, Ayers E, Verghese J, Nsubayi CK, Weiss EF. "However, as hypothesized, currently published cutpoints poorly discriminated cognitively impaired individuals from cognitively normal/SCC individuals in our ethnically/racially diverse sample, with a very high false-positive rate (79%)," the researchers wrote. Ultimately, the study concluded both the English and Spanish MoCA had adequate diagnostic accuracy in a population of culturally, educationally, and linguistically diverse older adults presenting to primary care with baseline cognitive concerns. The researchers found that previously published cutpoints exhibited good sensitivity but poor specificity for identifying cognitive impairment in the English MoCA, with particularly poor specificity in the Spanish MoCA. Optimal cut points for identifying cognitive impairment were 18.5 for English (sensitivity, 0.646 specificity, 0.774) and 16.5 for Spanish (sensitivity, 0.644 specificity, 0.729). ROC analyses, combining MCI and dementia, demonstrated an area under the curve of 0.785 for the English MoCA and 0.789 for the Spanish MoCA. After accounting for education, the language of the MoCA test ceased to be a significant factor ( P =. The English MoCA average (18.6) was significantly higher than the Spanish MoCA average (16.7) ( P <. Using the MoCA cut points proposed by Milani et al revealed a stark contrast, with only 10% classified as "cognitively normal" and 38% as "dementia," highlighting a significant discrepancy compared with neuropsychological tests. Neuropsychological testing identified 39% of participants as "cognitively normal/SCC," 58% as "MCI," and 3% as "dementia." The MoCA scores demonstrated significant differentiation between cognitive status levels ( P < 0.001). The overall mean (SD) MoCA score was 17.7 (4.3), ranging from 6 to 28. The English MoCA average was significantly higher at 18.6, compared with the Spanish MoCA average of 16.7 ( P <. 001).Ī majority of self-identified Hispanic individuals (87%) opted for testing in Spanish, while 89% of African American/Black individuals chose English testing. Notably, the English-speaking group had a significantly higher average education level (12.6 years) compared with the Spanish-speaking group (9.8 years) ( P <. Ethnicity distribution revealed that 42.4% identified as Hispanic and 38.5% identified as Black/African American. The mean (SD) education level was 11.2 (4.2) years. The final study population comprised 231 older adults with a mean (SD) age of 72.8 (5.9) years, with women constituting 72% of the participants. The researchers utilized one-way analysis of variance to compare cognitive statuses and performed receiver operating characteristic (ROC) analyses to identify optimal MoCA cut points for discriminating possible cognitive impairment. A neuropsychologist then determined the cognitive status of each participant, categorizing them into groups of normal with subjective cognitive concerns (SCC), mild cognitive impairment (MCI), or dementia. The participants underwent cognitive screening using both MoCA and neuropsychological measures, administered in either Spanish or English. The investigation included 231 participants 65 years and older who were attending outpatient primary care in the Bronx, New York, and had cognitive concerns. These findings underscore the imperative of tailoring cognitive assessments for diverse populations, shedding light on the need for precision in identifying cognitive decline among older adults with varying cultural and linguistic backgrounds, the study stated. Results revealed current cut points may lead to a high false-positive rate, prompting a call for lower thresholds in both language versions to enhance diagnostic accuracy.
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