Early Detection of Mild Alzheimer’s Disease in Filipino Elderly: Validation of the Montreal Cognitive Assessment-Philippines (MoCA-P)
Author(s)
Jacqueline C. Dominguez,
Jennifer Rose Soriano,
Cely D. Magpantay,
Mary Grace S. Orquiza,
Wynette Marie Solis,
Macario F. Reandelar Jr.,
Ma. Lourdes C. Joson
Affiliation(s)
Memory Center, Institute for Neurosciences, St. Luke’s Medical Center, Quezon City, Philippines.
Memory Center, Institute for Neurosciences, St. Luke’s Medical Center, Quezon City, Philippines.
ABSTRACT
Background: The Montreal Cognitive Assessment (MoCA) is a useful instrument employed by clinicians to detect cognitive impairment and diagnose probable Alzheimer’s Disease (AD) while in its early stages. Methods: A cross-sectional study was conducted to determine the diagnostic validity of the Philippine version of the MoCA (MoCA-P) among 1385 community-dwelling Filipino elderly from Marikina City, Metro Manila. Results: 509 controls and 97 elderly with probable AD and a Clinical Dementia Rating (CDR) global score of 0.5 were included in the analysis. Analysis of variance showed that the AD group was older (p < 0.05) and had fewer years of education (p < 0.05). The optimal cut-off score to differentiate controls from those with probable AD was 20/21, with a sensitivity of 0.835 and a specificity of 0.723, and area under the curve (AUC) of 0.89 (p < 0.001). The positive and negative likelihood ratios were 3.01 and 0.23, respectively; and pre- and post-test odds were 0.0951 and 0.2224, respectively. Logistic regression showed that the odds of scoring < 20 on the MoCA-P increased with advancing age and with education at ≤7 years (p < 0.05). Two points are added to the MoCA-P score for those with ≤7 years of education. Conclusion: The MoCA-P is a valid instrument for the early detection of mild AD among the Filipino elderly.
Background: The Montreal Cognitive Assessment (MoCA) is a useful instrument employed by clinicians to detect cognitive impairment and diagnose probable Alzheimer’s Disease (AD) while in its early stages. Methods: A cross-sectional study was conducted to determine the diagnostic validity of the Philippine version of the MoCA (MoCA-P) among 1385 community-dwelling Filipino elderly from Marikina City, Metro Manila. Results: 509 controls and 97 elderly with probable AD and a Clinical Dementia Rating (CDR) global score of 0.5 were included in the analysis. Analysis of variance showed that the AD group was older (p < 0.05) and had fewer years of education (p < 0.05). The optimal cut-off score to differentiate controls from those with probable AD was 20/21, with a sensitivity of 0.835 and a specificity of 0.723, and area under the curve (AUC) of 0.89 (p < 0.001). The positive and negative likelihood ratios were 3.01 and 0.23, respectively; and pre- and post-test odds were 0.0951 and 0.2224, respectively. Logistic regression showed that the odds of scoring < 20 on the MoCA-P increased with advancing age and with education at ≤7 years (p < 0.05). Two points are added to the MoCA-P score for those with ≤7 years of education. Conclusion: The MoCA-P is a valid instrument for the early detection of mild AD among the Filipino elderly.
Cite this paper
Dominguez, J. , Soriano, J. , Magpantay, C. , Orquiza, M. , Solis, W. , Reandelar Jr., M. and Joson, M. (2014) Early Detection of Mild Alzheimer’s Disease in Filipino Elderly: Validation of the Montreal Cognitive Assessment-Philippines (MoCA-P). Advances in Alzheimer's Disease, 3, 160-167. doi: 10.4236/aad.2014.34015.
Dominguez, J. , Soriano, J. , Magpantay, C. , Orquiza, M. , Solis, W. , Reandelar Jr., M. and Joson, M. (2014) Early Detection of Mild Alzheimer’s Disease in Filipino Elderly: Validation of the Montreal Cognitive Assessment-Philippines (MoCA-P). Advances in Alzheimer's Disease, 3, 160-167. doi: 10.4236/aad.2014.34015.
References
[1] Ferri, C.P., Prince, M., Brayne, C., Brodaty, H., Fratiglioni, L., Ganguli, M., et al. (2005) Global Prevalence of Dementia: A Delphi Consensus Study. The Lancet, 366, 2112-2117.
http://dx.doi.org/10.1016/S0140-6736(05)67889-0 [2] Crum, R.M., Anthony, J.C., Basset, S.S. and Folstein, M.F. (1993) Population-Based Norms for the Mini-Mental State Examination by Age and Educational Level. The Journal of the American Medical Association, 269, 2386-2391. http://dx.doi.org/10.1001/jama.1993.03500180078038 [3] Zheng, L., Teng, E.L., Varma, R., Mack, W.J., Mungas, D., Lu, P.H. and Chui, H.C. (2012) Chinese-Language Montreal Cognitive Assessment for Cantonese or Mandarin Speakers: Age, Education, and Gender Effects. International Journal of Alzheimer’s Disease, 2012. [4] Das, S.K., Banerjee, T.K., Mukherjee, C.S., Bose, P., Biswas, A., Hazra, A., et al. (2006) An Urban Community-Based Study of Cognitive Function among Non-Demented Elderly Population in India. Neurology Asia, 11, 37-48. [5] Ligsay, A.D. (2004) Validation of the Mini-Mental State Examination among the Filipino Elderly. M.Sc. Thesis, University of the Philippines, Manila. [6] Nasreddine, Z.S., Phillips, N.A., Bédirian, V., Charbonneasu, S., Whitehead, V., Collin, I., et al. (2005) The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment. Journal of the American Geriatrics Society, 53, 695-699. http://dx.doi.org/10.1111/j.1532-5415.2005.53221.x [7] Hachinski, V., Iadecola, C., Petersen, R.C., Breteler, M.M., Nyenhuis, D.L., Black, S.E., et al. (2006) National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards. Stroke, 37, 2220-2241.
http://dx.doi.org/10.1161/01.STR.0000237236.88823.47 [8] Kim, J.S., Kim, J.M., Kim, H.J., Yun, J.Y. and Jeon, B.S. (2013) Use of the Pill Questionnaire to Detect Cognitive Deficits and Assess Their Impact on Daily Life in Patients with Parkinson’s Disease. Neurology Asia, 18, 369-375. [9] Lee, J.Y., Dong, W.L., Cho, S.J., Na, D.L., Jeon, H.J., Kim, S.K., 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.
http://dx.doi.org/10.1177/0891988708316855 [10] Wen, H.B., Zhang, Z.X., Niu, F.S. and Li, L. (2008) The Application of Montreal Cognitive Assessment in Urban Chinese Residents of Beijing. Zonghua Nei Ke Za Zhi (Chinese Journal of Internal Medicine), 47, 36-39. [11] Rahman, T.T. and El Gaafary, M.M. (2009) Montreal Cognitive Assessment Arabic Version: Reliability and Validity Prevalence of Mild Cognitive Impairment among Elderly Attending Geriatric Clubs in Cairo. Geriatrics & Gerontology International, 9, 54-61.http://dx.doi.org/10.1111/j.1447-0594.2008.00509.x [12] Montreal Cognitive Assessment Hong Kong Version (HK MoCA).
http://www.mocatest.org/pdf_files/test/MoCA-Test-HongKong_2010.pdf [13] Dominguez, J.C., Orquiza, M.S., Soriano, J.R., Magpantay, C.D., Esteban, R.C., Corrales, M.L. and Ampil, E.R. (2013) Adaptation of Montreal Cognitive Assessment for Elderly Filipino Patients. East Asian Archives of Psychiatry, 23, 80- 85. [14] McKhann, G., Drachman, D., Folstein, M.F., Katzman, R., Price, D. and Stadlan, E.M. (1984) Clinical Diagnosis of Alzheimer Disease: Report of the NINCDS-ADRDA Work Group under the Auspices of the Department of Health and Human Services Task Force on Alzheimer Disease. Neurology, 34, 939-944. http://dx.doi.org/10.1212/WNL.34.7.939 [15] Morris, J.C. (1993) The Clinical Dementia Rating (CDR): Current Version and Scoring Rules. Neurology, 43, 2412-2414. http://dx.doi.org/10.1212/WNL.43.11.2412-a [16] Yesavage, J., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M. and Leirer, V.O. (1983) Development and Validation of a Geriatric Depression Screening Scale: A Preliminary Report. Journal of Psychiatric Research, 17, 37-49. http://dx.doi.org/10.1016/0022-3956(82)90033-4 [17] Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A. and Gornbein, J. (1994) The Neuropsychiatric Inventory: Comprehensive Assessment of Psychopathology in Dementia. Neurology, 44, 2308-2314. http://dx.doi.org/10.1212/WNL.44.12.2308 [18] Waldron-Perrine, B. and Axelrod, B.N. (2012) Determining an Appropriate Cutting Score for Indication of Impairment on the Montreal Cognitive Assessment. International Journal of Geriatric Psychiatry, 27, 1189-1194. http://dx.doi.org/10.1002/gps.3768 [19] 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 US. International Journal of Geriatric Psychiatry, 24, 197- 201. http://dx.doi.org/10.1002/gps.2101 [20] Lee, J.Y., Dong, W.L., Cho, S.J., Na, D.L., Jeon, H.J., Kim, S.K., 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.
http://dx.doi.org/10.1177/0891988708316855 [21] Fujiwara, Y., Suzuki, H., Yasunaga, M., Sugiyama, M., Ijuin, M., Sakuma, N., et al. (2010) Brief Screening Tool for Mild Cognitive Impairment in Older Japanese: Validation of the Japanese Version of the Montreal Cognitive Assessment. Geriatrics & Gerontology International, 10, 225-232.
http://dx.doi.org/10.1111/j.1447-0594.2010.00585.x [22] Memória, C.M., Yassuda, M.S., Nakano, E.Y. and Forlenza, O.V. (2013) Brief Screening for Mild Cognitive Impairment: Validation of the Brazilian Version of the Montreal Cognitive Assessment. International Journal of Geriatric Psychiatry, 28, 34-40. http://dx.doi.org/10.1002/gps.3787 [23] Gomez, F., Zunzunegui, M., Lord, C., Alvarado, B. and Garcia, A. (2013) Applicability of the MoCA-S Test in Populations with Little Education in Colombia. International Journal of Geriatric Psychiatry, 28, 813-820. http://dx.doi.org/10.1002/gps.3885
[1] Ferri, C.P., Prince, M., Brayne, C., Brodaty, H., Fratiglioni, L., Ganguli, M., et al. (2005) Global Prevalence of Dementia: A Delphi Consensus Study. The Lancet, 366, 2112-2117.
http://dx.doi.org/10.1016/S0140-6736(05)67889-0 [2] Crum, R.M., Anthony, J.C., Basset, S.S. and Folstein, M.F. (1993) Population-Based Norms for the Mini-Mental State Examination by Age and Educational Level. The Journal of the American Medical Association, 269, 2386-2391. http://dx.doi.org/10.1001/jama.1993.03500180078038 [3] Zheng, L., Teng, E.L., Varma, R., Mack, W.J., Mungas, D., Lu, P.H. and Chui, H.C. (2012) Chinese-Language Montreal Cognitive Assessment for Cantonese or Mandarin Speakers: Age, Education, and Gender Effects. International Journal of Alzheimer’s Disease, 2012. [4] Das, S.K., Banerjee, T.K., Mukherjee, C.S., Bose, P., Biswas, A., Hazra, A., et al. (2006) An Urban Community-Based Study of Cognitive Function among Non-Demented Elderly Population in India. Neurology Asia, 11, 37-48. [5] Ligsay, A.D. (2004) Validation of the Mini-Mental State Examination among the Filipino Elderly. M.Sc. Thesis, University of the Philippines, Manila. [6] Nasreddine, Z.S., Phillips, N.A., Bédirian, V., Charbonneasu, S., Whitehead, V., Collin, I., et al. (2005) The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment. Journal of the American Geriatrics Society, 53, 695-699. http://dx.doi.org/10.1111/j.1532-5415.2005.53221.x [7] Hachinski, V., Iadecola, C., Petersen, R.C., Breteler, M.M., Nyenhuis, D.L., Black, S.E., et al. (2006) National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards. Stroke, 37, 2220-2241.
http://dx.doi.org/10.1161/01.STR.0000237236.88823.47 [8] Kim, J.S., Kim, J.M., Kim, H.J., Yun, J.Y. and Jeon, B.S. (2013) Use of the Pill Questionnaire to Detect Cognitive Deficits and Assess Their Impact on Daily Life in Patients with Parkinson’s Disease. Neurology Asia, 18, 369-375. [9] Lee, J.Y., Dong, W.L., Cho, S.J., Na, D.L., Jeon, H.J., Kim, S.K., 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.
http://dx.doi.org/10.1177/0891988708316855 [10] Wen, H.B., Zhang, Z.X., Niu, F.S. and Li, L. (2008) The Application of Montreal Cognitive Assessment in Urban Chinese Residents of Beijing. Zonghua Nei Ke Za Zhi (Chinese Journal of Internal Medicine), 47, 36-39. [11] Rahman, T.T. and El Gaafary, M.M. (2009) Montreal Cognitive Assessment Arabic Version: Reliability and Validity Prevalence of Mild Cognitive Impairment among Elderly Attending Geriatric Clubs in Cairo. Geriatrics & Gerontology International, 9, 54-61.http://dx.doi.org/10.1111/j.1447-0594.2008.00509.x [12] Montreal Cognitive Assessment Hong Kong Version (HK MoCA).
http://www.mocatest.org/pdf_files/test/MoCA-Test-HongKong_2010.pdf [13] Dominguez, J.C., Orquiza, M.S., Soriano, J.R., Magpantay, C.D., Esteban, R.C., Corrales, M.L. and Ampil, E.R. (2013) Adaptation of Montreal Cognitive Assessment for Elderly Filipino Patients. East Asian Archives of Psychiatry, 23, 80- 85. [14] McKhann, G., Drachman, D., Folstein, M.F., Katzman, R., Price, D. and Stadlan, E.M. (1984) Clinical Diagnosis of Alzheimer Disease: Report of the NINCDS-ADRDA Work Group under the Auspices of the Department of Health and Human Services Task Force on Alzheimer Disease. Neurology, 34, 939-944. http://dx.doi.org/10.1212/WNL.34.7.939 [15] Morris, J.C. (1993) The Clinical Dementia Rating (CDR): Current Version and Scoring Rules. Neurology, 43, 2412-2414. http://dx.doi.org/10.1212/WNL.43.11.2412-a [16] Yesavage, J., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M. and Leirer, V.O. (1983) Development and Validation of a Geriatric Depression Screening Scale: A Preliminary Report. Journal of Psychiatric Research, 17, 37-49. http://dx.doi.org/10.1016/0022-3956(82)90033-4 [17] Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A. and Gornbein, J. (1994) The Neuropsychiatric Inventory: Comprehensive Assessment of Psychopathology in Dementia. Neurology, 44, 2308-2314. http://dx.doi.org/10.1212/WNL.44.12.2308 [18] Waldron-Perrine, B. and Axelrod, B.N. (2012) Determining an Appropriate Cutting Score for Indication of Impairment on the Montreal Cognitive Assessment. International Journal of Geriatric Psychiatry, 27, 1189-1194. http://dx.doi.org/10.1002/gps.3768 [19] 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 US. International Journal of Geriatric Psychiatry, 24, 197- 201. http://dx.doi.org/10.1002/gps.2101 [20] Lee, J.Y., Dong, W.L., Cho, S.J., Na, D.L., Jeon, H.J., Kim, S.K., 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.
http://dx.doi.org/10.1177/0891988708316855 [21] Fujiwara, Y., Suzuki, H., Yasunaga, M., Sugiyama, M., Ijuin, M., Sakuma, N., et al. (2010) Brief Screening Tool for Mild Cognitive Impairment in Older Japanese: Validation of the Japanese Version of the Montreal Cognitive Assessment. Geriatrics & Gerontology International, 10, 225-232.
http://dx.doi.org/10.1111/j.1447-0594.2010.00585.x [22] Memória, C.M., Yassuda, M.S., Nakano, E.Y. and Forlenza, O.V. (2013) Brief Screening for Mild Cognitive Impairment: Validation of the Brazilian Version of the Montreal Cognitive Assessment. International Journal of Geriatric Psychiatry, 28, 34-40. http://dx.doi.org/10.1002/gps.3787 [23] Gomez, F., Zunzunegui, M., Lord, C., Alvarado, B. and Garcia, A. (2013) Applicability of the MoCA-S Test in Populations with Little Education in Colombia. International Journal of Geriatric Psychiatry, 28, 813-820. http://dx.doi.org/10.1002/gps.3885