Objective: To determine the discriminant ability of the Montreal Cognitive Assessment (MOCA) for detection of dementia or any cognitive impairment in patients with Parkinson’s disease (PD) from a tertiary referral hospital in Colombia. Secondary objectives were to identify potential cutoffs for MOCA in this population and compare MOCA with Minimental State Examination (MMSE) scores as screening tools for cognitive deficits in PD.

Background: MOCA is widely used as screening tool for cognitive impairment in PD. However, the sensitivity and specificity, as well as the cutoffs for detecting dementia and mild cognitive impairment in PD differ across studies, probably due to variability of populations. There are not previous studies in Latin America.

Methods: Prospective cross-sectional diagnostic accuracy study conducted in 50 consecutive patients at one center in Bogotá, Colombia. Inclusion criteria were patients aged between 45 and 80 years with diagnosis of PD and Hoehn & Yahr stage 1-4. Patients underwent a comprehensive neurological and neuropsychological assessment (gold standard) in order to classify them in PD with dementia (PDD), PD with mild cognitive impairment (PD-MCI) (level II of MDS criteria) and PD without cognitive disorder. MOCA and MMSE were applied to all patients by an investigator blinded to the “Gold Standard” results.

Results: A total of 50 patients with PD were evaluated. One patient was excluded due to severe depression, 15 patients met the criteria for PDD (30.6%) and 18 for PD-MCI (36.7%). The median MOCA score in PDD was 17 (IQR 14-19) vs. 25 in non-demented (IQR 23-27), p<0.001. A MOCA cutoff score ≤20 showed a sensitivity of 100% and specificity of 97% to detect PDD, while a cutoff score ≤24 had a sensitivity of 88% and specificity of 87.5% to detect any cognitive disorder in PD (either dementia or PD-MCI). The discriminative power of MOCA was higher than MMSE for detecting PDD (area under the receiver-operating characteristics curve [95% confidence interval] for MOCA was 0.99 [0.99-1] vs. MMSE 0.82 [0.69-0.96], p<0.01).

Conclusions: In our population MOCA showed good psychometric properties to detect cognitive impairment in PD. The cutoffs scores of MOCA for this Colombian population differ from other studies on western countries. These differences are probably related to level of education, which was lower in our patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/utility-of-the-montreal-cognitive-assessment-for-screening-of-mild-cognitive-impairment-and-dementia-associated-with-parkinsons-disease-in-a-colombian-hospital/