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The Montreal Cognitive Assessment (MoCA) in geriatric rehabilitation: psychometric properties and association with rehabilitation outcomes

Published online by Cambridge University Press:  01 August 2011

Lisa Sweet ,
Mike Van Adel ,
Valerie Metcalf ,
Lisa Wright ,
Anne Harley ,
René Leiva  and
Vanessa Taler
Lisa Sweet*
Affiliation:
Memory Disorder Clinic, Bruyère Continuing Care, Ottawa, Ontario, Canada
Mike Van Adel
Affiliation:
Elisabeth Bruyère Research Institute, Ottawa and University of Ottawa, Faculty of Social Sciences, Ottawa, Ontario, Canada
Valerie Metcalf
Affiliation:
Geriatric Rehabilitation Service, Bruyère Continuing Care, Ottawa, Ontario, Canada
Lisa Wright
Affiliation:
Geriatric Rehabilitation Service, Bruyère Continuing Care, Ottawa, Ontario, Canada
Anne Harley
Affiliation:
Geriatric Rehabilitation Service, Bruyère Continuing Care, Ottawa, Ontario, Canada
René Leiva
Affiliation:
Geriatric Rehabilitation Service, Bruyère Continuing Care, Ottawa, Ontario, Canada
Vanessa Taler
Affiliation:
Elisabeth Bruyère Research Institute, Ottawa and University of Ottawa, Faculty of Social Sciences, Ottawa, Ontario, Canada
*
Correspondence should be addressed to: Lisa Sweet, Memory Disorder Clinic, Bruyère Continuing Care, 43 Bruyère Street, Ottawa ON K1N 5C8, Canada. Phone: +1 613–562-6262 ext. 1368; Fax: +1 613–562-6013. Email: LSweet@bruyere.org.
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Abstract

Background: Cognitive status has been reported to be an important predictor of rehabilitation outcome. The Montreal Cognitive Assessment (MoCA) was designed to overcome some of the limitations of established cognitive screening tools such as the Mini-Mental State Examination (MMSE). The purpose of this study is to evaluate the psychometric characteristics of the MoCA as a screening tool in a geriatric rehabilitation program and its ability to predict rehabilitation outcome.

Methods: Forty-seven geriatric rehabilitation program patients participated in the study. Assessments of each patient's functional (Functional Independence Measure) and cognitive status (MMSE and MoCA) were performed. Information on discharge destinations were obtained and rehabilitation efficacy and efficiency scores were calculated.

Results: Significant correlations were found between the MoCA and other cognitive status measures. Cognitive status at admission and successful rehabilitation were also associated. Defining rehabilitation success on the basis of relative functional efficacy (an indicator that includes the patient's potential for improvement), the sensitivity and specificity of the MoCA were 80% and 30% respectively. The attention subscale of the MoCA was also uniquely predictive of rehabilitation success. The attention subscale (cutoff 5/6) of the MoCA had a sensitivity of 40% and specificity of 90%, as did the MMSE.

Conclusions: As a cognitive screening tool, the MoCA appears to have acceptable psychometric properties. Results suggest that the MoCA can have a considerable advantage over the MMSE in sensitivity and equivalence in specificity using both total and attention scale scores. The MoCA may be a more useful measure for detecting cognitive impairment and predicting rehabilitation outcome in this population.

Keywords

mental statuscognitive assessmentMontreal Cognitive Assessmentrehabilitation outcomegeriatric rehabilitation
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 10 , December 2011 , pp. 1582 - 1591
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Barnes, C., Conner, D., Legault, L., Reznickova, N. and Harrison-Felix, C. (2004). Rehabilitation outcomes in cognitively impaired patients admitted to skilled nursing facilities from the community. Archives of Physical Medicine and Rehabilitation, 85, 1602–1607.Google Scholar
Bottger, S., Prosiegel, M., Steiger, H. J. and Yassouridis, A. (1998) Neurobehavioural disturbances, rehabilitation outcome, and lesion site in patients after rupture and repair of anterior communicating artery aneurysm. Journal of Neurology, Neurosurgery and Psychiatry, 65, 93–102.Google Scholar
Brink, T. L., Yesavage, J. A., Lum, O., Heersema, P., Adey, M. and Rose, T. L. (1982). Screening test for geriatric depression. Clinical Gerontologist, 1, 37–43.CrossRefGoogle Scholar
Canadian Institute of Health Information (2010). National Rehabilitation Reporting System. Available at: www.cihi.ca; last accessed 15 June 2010.Google Scholar
Diamond, P. T., Felsenthal, G., Macciocchi, S. N., Butler, D.H. and Lally-Cassady, D. (1996). Effect of cognitive impairment on rehabilitation outcome. American Journal of Physical Medicine and Rehabilitation, 75, 40–43.CrossRefGoogle ScholarPubMed
Dodds, T. A., Martin, D. P., Stolov, W. C. and Deyo, R. A. (1993). A validation of the Functional Independence Measure and its performance among rehabilitation inpatients. Archives of Physical Medicine and Rehabilitation, 74, 531–536.CrossRefGoogle ScholarPubMed
Drubach, D. A., Kelly, M. P. and Taragano, F. E. (1994). The Montebello rehabilitation factor score. Journal of NeuroEngineering and Rehabilitation, 8, 92–96.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Fullam, R., Howard, E., Pridham, J., Callaghan, J., Craufurd, D. and Thompson, J. (2010). An exploratory analysis of the sensitivity of the Montreal Cognitive Assessment in Huntington's disease. Journal of Neurology, Neurosurgery and Psychiatry, 81, A32.CrossRefGoogle Scholar
Ghisla, M. K., Cossi, S., Timpini, A., Baroni, F., Facchi, E. and Marengoni, A. (2007). Predictors of successful rehabilitation in geriatric patients: subgroup analysis of patients with cognitive impairment. Ageing: Clinical and Experimental Research, 19, 417–423.Google ScholarPubMed
Goldstein, F. C., Strasser, D. C., Woodard, J. L. and Roberts, V. J. (1997). Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. Journal of the American Geriatrics Society, 45, 35–42.Google Scholar
Gray, D. S. (2000) Slow-to-recover severe traumatic brain injury: a review of outcomes and rehabilitation effectiveness. Brain Injury, 14, 1003–1014.CrossRefGoogle ScholarPubMed
Heruti, R. J., Lusky, , Barell, A., Ohry, V., Adunsky, A., , A. (1999). Cognitive status at admission: does it affect the rehabilitation outcome of elderly patients with hip fracture? Archives of Physical Medicine Rehabilitation, 80, 432–436.CrossRefGoogle ScholarPubMed
Heruti, R. J., Lusky, A. and Dankner, R. (2002). Rehabilitation outcome of elderly patients after a first stroke: Effect of cognitive status at admission on the functional outcome. Archives of Physical Medicine and Rehabilitation, 83, 742–749.Google Scholar
Hershkovitz, A. and Brill, S. (2007). The association between patients’ cognitive status and rehabilitation outcome in a geriatric day hospital. Disability and Rehabilitation, 29, 333–337.CrossRefGoogle Scholar
Hoops, S. et al. . (2009). Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology, 73, 1738–1745.CrossRefGoogle ScholarPubMed
Ihl, R., Frolieh, T. D. and Martin, E. M. (1992). Differential validity of psychometric tests in dementia of Alzheimer type. Psychiatry Research, 44, 93–106.CrossRefGoogle Scholar
Kidd, P. M. (2008). Alzheimer's disease, amnestic mild cognitive impairment, and age associated memory impairment: current understanding and progress toward integrative prevention. Alternative Medicine Review, 13, 85.Google ScholarPubMed
Knoefel, F. D., Helliwell, B., Seabrook, J. A., Borrie, M. J., Stolee, P. and Wells, J. L. (2003). A comparison of functionnal independence and medical complexity in geriatric and physical medicine rehabilitation in-patients. Geriatrics Today, 6, 90–94.Google Scholar
Landi, F. et al. (2002). Predictors of rehabilitation outcomes in frail patients treated in a geriatric hospital. Journal of the American Geriatrics Society, 50, 679–684.Google Scholar
Lee, Y. et al. (2008). Brief screening for mild cognitive impairment in elderly outpatient clinic: validation of the Korean version of the Montreal Cognitive Assessment. Journal of Geriatric Psychiatry and Neurology, 21, 104–110.CrossRefGoogle ScholarPubMed
Liu-Ambrose, Y., Ashe, M. C., Graf, P., Beattie, B. L. and Khan, K. M. (2008). Increased risk of falling in older community-dwelling women with mild cognitive impairment. Physical Therapy, 88, 1482–1491.CrossRefGoogle ScholarPubMed
Luis, C. A., Keegan, A. P. and Mullan, M. (2009). Cross-validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the southeastern USA. International Journal of Geriatric Psychiatry, 24, 197–201.Google Scholar
MacNeill, S. E., Gerskovich, T., Caron, J. and Lichtenberg, P. A. (1997). Living alone: predictors of recovery during medical rehabilitation. Clinical Gerontologist, 18, 3–13.CrossRefGoogle Scholar
Martinic-Popovic, I., Serci, V. and Demarin, V. (2007). Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. Neurological Sciences, 257, 185–193.Google Scholar
McDowd, J., Filion, D. L., Pohl, P. S., Richards, L. G. and Stiers, W. (2003). Attentional abilities and functional outcomes following stroke. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 58, 45–53.CrossRefGoogle ScholarPubMed
Melton, L. J. (2003). Adverse outcomes of osteoporotic fractures in the general population. Journal of Bone and Mineral Research, 18, 1139–1141.Google Scholar
Nasreddine, Z.S., Philips, N.A., Bedirian, V., Charbonneau, S., Whitehead, V. and Collin, I. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695–699.CrossRefGoogle Scholar
Nazem, S. et al. (2009). Parkinson's disease with “normal” global cognition according to Mini-Mental State Examination score. Journal of the American Geriatrics Society, 57, 304–308.CrossRefGoogle ScholarPubMed
Olson, R. A., Chhanabhai, T. and McKenzie, M. (2008) Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases. Support Care Cancer, 16, 1273–1278.CrossRefGoogle ScholarPubMed
Ottenbacher, K. J., Mann, W. C., Granger, C. V., Tomita, M., Hurren, D. and Charvat, B. (1994). Inter-rater agreement and stability of functional assessment in the community-based elderly. Archives of Physical Medicine and Rehabilitation, 75, 1297–1301.Google Scholar
Paolucci, S., Antonucci, G., Guariglia, C., Magnotti, L., Pazzamigli, L. O. and Zoccolotti, P. (1996) Facilitory effect of neglect rehabilitation on the recovery of left hemiplegic stroke patients: a crossover study. Journal of Neurology, 243, 308–314.Google Scholar
Patrick, L., Leber, M. and Johnston, S. (1996). Aspects of cognitive status as predictors of mobility following geriatric rehabilitation. Ageing: Clinical and Experimental Research, 8, 328–333.Google Scholar
Patrick, L., Gaskowski, P. and Rexroth, D. (2002a). Cumulative illness and neuropsychological decline in hospitalized geriatric patients. Clinical Neuropsychology, 16, 145–156.CrossRefGoogle ScholarPubMed
Patrick, L., Perugini, M. and Leclerc, C. (2002b). Neuropsychological assessment and competency for independent living among geriatric patients. Topics in Geriatric Rehabilitation, 14, 65–77.CrossRefGoogle Scholar
Robertson, I. H., Ridgeway, V., Greenfield, E. and Parr, A. (1997) Motor recovery after stroke depends on intact sustained attention: a 2-year follow-up study. Neuropsychology, 11, 290–295.CrossRefGoogle ScholarPubMed
Schultz-Larsen, K., Lomholt, R. K. and Kreiner, S. (2007). Mini-Mental Status Examination: a short form of MMSE was as accurate as the original MMSE in predicting dementia. Journal of Clinical Epidemiology, 60, 260–267.CrossRefGoogle Scholar
Shiroky, J. S., Hyman, H. M., Bergman, H. and Chertkow, H. (2007). Can you have dementia with an MMSE Score of 30? American Journal of Alzheimer's Disease and Other Dementias, 22, 406–415.CrossRefGoogle ScholarPubMed
Tombaugh, T. N. and Mclntyre, N. J. (1992). The Mini-Mental State Examination: a comprehensive review. Journal of the American Geriatrics Society, 40, 922–935.Google Scholar
Wells, J. L., Seabrook, J. A., Stolee, P., Borrie, M. J. and Knoefel, F. (2003). State of the art in geriatric rehabilitation: Part I. Review of frailty and comprehensive geriatric assessment. Archives of Physical Medicine and Rehabilitation, 84, 890–897.Google Scholar
Wind, A. W. et al. (1997). Limitations of the Mini-Mental State Examination in diagnosing dementia in general practice. International Journal of Geriatric Psychiatry, 12,101–108.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
Zadikoff, C. et al. (2008). A comparison of the Mini -Mental State Exam to the Montreal Cognitive Assessment in identifying cognitive deficits in Parkinson's disease. Movement Disorders, 23, 297–299.CrossRefGoogle Scholar