A 25-point cutoff for the MoCA generated a better balance between sensitivity (81%) and specificity (77%) in detecting NCD. Memória, Yassuda, Nakano, and Forlenza (2013) observed the need to add a point for participants with less than 12 years of schooling, in order to correct for the effects of education. In MoCA original investigation, a cutoff of 26 points produced a balance between sensitivity (90% for NCD and 100% for AD) and specificity (87%) ( Nasreddine et al., 2005). To detect subtle cognitive deficits, which are typical of early stages, new screening tools were developed, such as Montreal Cognitive Assessment (MoCA), with tasks that are more complex and expanded to executive function and visuospatial processing, which are usually affected in NCD. It was concluded that extra care must be taken to use MMSE across educational levels due to its mild sensitivity in detecting early deficits related to dementia and NCD. Mitchell’s meta-analysis ( 2009) investigated the use of the MMSE as a screening measure for 34 studies of dementia and five studies of NCD. However, there is a current criticism whether it could detect cognitive deficits in the early stages of brain pathology ( Loewenstein, 2015) due to the high percentage of ceiling effect ( Anthony, LeResche, Niaz, von Korff, & Folstein, 1982). Consequently, it is well established not only as a screening tool broadly used in research and clinical settings but also for repeated application ( Creavin et al., 2016). The MMSE is useful for studying deterioration of cognitive abilities as an index of dementing diseases progression ( Folstein, Folstein, & McHugh, 1975) and the effect of pharmacological and non-pharmacological interventions. In a study by Brucki and colleagues (2003), it was shown that educational level was the most important factor in determining cognitive losses in several clinical groups, and the cutoff scores for Alzheimer’s disease (AD) according to years of schooling were as follows: 20 points for adults within 1–4 years 26.5 points for those with 5–8 years 28 points for those with 9–11 years and 29 points for patients with educational levels greater than 11 years. In developing countries, different cutoff levels for the MMSE were established in order to minimize possible diagnostic errors related to literacy and schooling ( Bertolucci et al., 1994). The strengths of MMSE are its psychometrical properties, especially reliability ( Mitrushina & Satz, 1991 O’Connor et al, 1989). It has been used worldwide, even before NCD was recognized in medical guidelines ( Petersen et al., 2014). The best known is the Mini-Mental State Examination (MMSE), designed for the detection cognitive deficits–especially regarding attention, memory, and language functions–observed in the process of dementia. Such tools are quick and easy to apply, and with adequate training may be used by different types of health care professionals ( Bertolucci, Brucki, Campacci, & Juliano, 1994). Screening tools have been developed to detect cognitive dysfunction in elderly individuals ( Brucki, Nitrini, Caramelli, Bertolucci, & Okamoto, 2003). The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) ( American Psychiatric Association, 2013) stands out the NCD may occur secondary to other conditions, for instance, hormonal, nutritional, and infectious diseases, and comorbidities such as neuropsychiatric disorders. The criteria for NCD are as follows: (a) evidence of mild cognitive deterioration, (i) concern for the patient or informer and (ii) mild cognitive performance impairment (z scores between −1 and −2) (b) nondisturbance of daily activities (c) impairments do not occur in the context of delirium and (d) impairments are not better explained by other mental disorders (i.e., major depressive disorder). Neurocognitive disorders (NCDs) or mild cognitive impairment (MCI World Health Organization, 2016) may be defined as a transitory condition between typical cognitive behavior and dementia ( Petersen et al., 2009). Mini-Mental State Examination, Montreal Cognitive Assessment, Cognition, Psychology of aging/psychiatry
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