The Montreal Cognitive Assessment (MoCA) with a double threshold: improving the MoCA for triaging patients in need of a neuropsychological assessment.

Autor:	Dautzenberg GMFC; Altrecht Institute for Mental Health Care, Old Age Psychiatry, Soestwetering 1, 3543AZ Utrecht, The Netherlands.; Department of Psychiatry, Amsterdam UMC, location VUmc and GGZ inGeest, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands., Lijmer JG; Department of Psychiatry, OLVG Hospital, Postbus 95500, 1090 HM, Amsterdam, The Netherlands., Beekman ATF; Department of Psychiatry, Amsterdam UMC, location VUmc and GGZ inGeest, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	International psychogeriatrics [Int Psychogeriatr] 2022 Jun; Vol. 34 (6), pp. 571-583. Date of Electronic Publication: 2021 Aug 31.
DOI:	10.1017/S1041610221000612
Abstrakt:	Objectives: Diagnosis of patients suspected of mild dementia (MD) is a challenge and patient numbers continue to rise. A short test triaging patients in need of a neuropsychological assessment (NPA) is welcome. The Montreal cognitive assessment (MoCA) has high sensitivity at the original cutoff <26 for MD, but results in too many false-positive (FP) referrals in clinical practice (low specificity). A cutoff that finds all patients at high risk of MD without referring to many patients not (yet) in need of an NPA is needed. A difficulty is who is to be considered at risk, as definitions for disease (e.g. MD) do not always define health at the same time and thereby create subthreshold disorders. Design: In this study, we compared different selection strategies to efficiently identify patients in need of an NPA. Using the MoCA with a double threshold tackles the dilemma of increasing the specificity without decreasing the sensitivity and creates the opportunity to distinguish the clinical (MD) and subclinical (MCI) state and hence to get their appropriate policy. Setting/participants: Patients referred to old-age psychiatry suspected of cognitive impairment that could benefit from an NPA ( n = 693). Results: The optimal strategy was a two-stage selection process using the MoCA with a double threshold as an add-on after initial assessment. By selecting who is likely to have dementia and should be assessed further (MoCA<21), who should be discharged (≥26), and who's course should be monitored actively as they are at increased risk (21<26). Conclusion: By using two cutoffs, the clinical value of the MoCA improved for triaging. A double-threshold MoCA not only gave the best results; accuracy, PPV, NPV, and reducing FP referrals by 65%, still correctly triaging most MD patients. It also identified most MCIs whose intermediate state justifies active monitoring.
Databáze:	MEDLINE
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