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Impact of Different Operational Definitions on Mild Cognitive Impairment Rate and MMSE and MoCA Performance in Transient Ischaemic Attack and Stroke

BACKGROUND: Mild cognitive impairment (MCI) is at least as prevalent as dementia after transient ischaemic attack (TIA)/stroke and is increasingly recognised as an important outcome in observational studies and randomised trials. However, there is no consensus on how impairment should be defined, an...

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Autores principales: Pendlebury, Sarah T., Mariz, Jose, Bull, Linda, Mehta, Ziyah, Rothwell, Peter M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3902763/
https://www.ncbi.nlm.nih.gov/pubmed/24217342
http://dx.doi.org/10.1159/000355496
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author Pendlebury, Sarah T.
Mariz, Jose
Bull, Linda
Mehta, Ziyah
Rothwell, Peter M.
author_facet Pendlebury, Sarah T.
Mariz, Jose
Bull, Linda
Mehta, Ziyah
Rothwell, Peter M.
author_sort Pendlebury, Sarah T.
collection PubMed
description BACKGROUND: Mild cognitive impairment (MCI) is at least as prevalent as dementia after transient ischaemic attack (TIA)/stroke and is increasingly recognised as an important outcome in observational studies and randomised trials. However, there is no consensus on how impairment should be defined, and numerous different criteria exist. Previous studies have shown that different criteria for cognitive impairment impact on prevalence rates in epidemiological studies. However, there are few data on how operational differences within established criteria (e.g. Petersen-MCI) affect measured impairment rates and the performance of short cognitive tests such as the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), particularly in cerebrovascular disease. We therefore evaluated the effect of different operational definitions on measured rates of Petersen-MCI and on reliability of short cognitive tests in patients with TIA and stroke. METHODS: Consecutive patients underwent the MMSE, MoCA and neuropsychological battery ≥1 year after TIA or stroke in a population-based study. MCI was defined using the Petersen method and subclassified as single or multiple domain, both with (original) and without (modified) subjective memory impairment. Different cut-offs (>1, >1.5 and >2 standard deviations, SD) on a given test relative to published norms were compared together with use of single versus multiple tests to define domain impairment. RESULTS: 91 non-demented subjects completed neuropsychological testing (mean age ± SD 69.7 ± 11.6 years, 54 male, 49 stroke) at a mean of 3.1 ± 1.9 years after the index event. Rates of cognitive impairment ranged from 14/91 (15%) for MCI-original at >2 SD cut-off to 61/91 (67%) MCI-modified at >1 SD cut-off, and the proportion of MCI that was multiple domain varied, e.g. 24/46 (52%) versus only 5/27 (20%) at 1 versus 2 SD cut-off for MCI-modified. Requirement for subjective memory complaint approximately halved estimates [e.g. 17 (19%) vs. 39 (43%) for MCI at 1.5 SD cut-off, single test definition], whereas use of multiple tests versus a single test to define a cognitive domain had less impact. In general, diagnostic accuracy was higher, and optimal cut-offs lower, on MMSE and MoCA for multiple-domain versus single-domain MCI, but the MoCA appeared superior for detecting MCI-modified, whereas the MMSE performed well in detecting MCI-original. CONCLUSION: Even within established criteria for MCI, differences in operational methodology result in 4-fold variation in MCI estimates. Optimal MMSE and MoCA cut-offs are lower, and reliability more similar, when criteria for MCI are more stringent. Our findings have implications for sample size and adjusted relative risk calculations in randomised trials and for comparisons between studies.
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spelling pubmed-39027632014-01-28 Impact of Different Operational Definitions on Mild Cognitive Impairment Rate and MMSE and MoCA Performance in Transient Ischaemic Attack and Stroke Pendlebury, Sarah T. Mariz, Jose Bull, Linda Mehta, Ziyah Rothwell, Peter M. Cerebrovasc Dis Original Paper BACKGROUND: Mild cognitive impairment (MCI) is at least as prevalent as dementia after transient ischaemic attack (TIA)/stroke and is increasingly recognised as an important outcome in observational studies and randomised trials. However, there is no consensus on how impairment should be defined, and numerous different criteria exist. Previous studies have shown that different criteria for cognitive impairment impact on prevalence rates in epidemiological studies. However, there are few data on how operational differences within established criteria (e.g. Petersen-MCI) affect measured impairment rates and the performance of short cognitive tests such as the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), particularly in cerebrovascular disease. We therefore evaluated the effect of different operational definitions on measured rates of Petersen-MCI and on reliability of short cognitive tests in patients with TIA and stroke. METHODS: Consecutive patients underwent the MMSE, MoCA and neuropsychological battery ≥1 year after TIA or stroke in a population-based study. MCI was defined using the Petersen method and subclassified as single or multiple domain, both with (original) and without (modified) subjective memory impairment. Different cut-offs (>1, >1.5 and >2 standard deviations, SD) on a given test relative to published norms were compared together with use of single versus multiple tests to define domain impairment. RESULTS: 91 non-demented subjects completed neuropsychological testing (mean age ± SD 69.7 ± 11.6 years, 54 male, 49 stroke) at a mean of 3.1 ± 1.9 years after the index event. Rates of cognitive impairment ranged from 14/91 (15%) for MCI-original at >2 SD cut-off to 61/91 (67%) MCI-modified at >1 SD cut-off, and the proportion of MCI that was multiple domain varied, e.g. 24/46 (52%) versus only 5/27 (20%) at 1 versus 2 SD cut-off for MCI-modified. Requirement for subjective memory complaint approximately halved estimates [e.g. 17 (19%) vs. 39 (43%) for MCI at 1.5 SD cut-off, single test definition], whereas use of multiple tests versus a single test to define a cognitive domain had less impact. In general, diagnostic accuracy was higher, and optimal cut-offs lower, on MMSE and MoCA for multiple-domain versus single-domain MCI, but the MoCA appeared superior for detecting MCI-modified, whereas the MMSE performed well in detecting MCI-original. CONCLUSION: Even within established criteria for MCI, differences in operational methodology result in 4-fold variation in MCI estimates. Optimal MMSE and MoCA cut-offs are lower, and reliability more similar, when criteria for MCI are more stringent. Our findings have implications for sample size and adjusted relative risk calculations in randomised trials and for comparisons between studies. S. Karger AG 2013-12 2013-11-08 /pmc/articles/PMC3902763/ /pubmed/24217342 http://dx.doi.org/10.1159/000355496 Text en Copyright © 2013 by S. Karger AG, Basel http://creativecommons.org/licenses/by/3.0/ This is an Open Access article licensed under the terms of the Creative Commons Attribution 3.0 Unported license (CC BY 3.0) (www.karger.com/OA-license-WT), applicable to the online version of the article only. Users may download, print and share this work on the Internet, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.
spellingShingle Original Paper
Pendlebury, Sarah T.
Mariz, Jose
Bull, Linda
Mehta, Ziyah
Rothwell, Peter M.
Impact of Different Operational Definitions on Mild Cognitive Impairment Rate and MMSE and MoCA Performance in Transient Ischaemic Attack and Stroke
title Impact of Different Operational Definitions on Mild Cognitive Impairment Rate and MMSE and MoCA Performance in Transient Ischaemic Attack and Stroke
title_full Impact of Different Operational Definitions on Mild Cognitive Impairment Rate and MMSE and MoCA Performance in Transient Ischaemic Attack and Stroke
title_fullStr Impact of Different Operational Definitions on Mild Cognitive Impairment Rate and MMSE and MoCA Performance in Transient Ischaemic Attack and Stroke
title_full_unstemmed Impact of Different Operational Definitions on Mild Cognitive Impairment Rate and MMSE and MoCA Performance in Transient Ischaemic Attack and Stroke
title_short Impact of Different Operational Definitions on Mild Cognitive Impairment Rate and MMSE and MoCA Performance in Transient Ischaemic Attack and Stroke
title_sort impact of different operational definitions on mild cognitive impairment rate and mmse and moca performance in transient ischaemic attack and stroke
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3902763/
https://www.ncbi.nlm.nih.gov/pubmed/24217342
http://dx.doi.org/10.1159/000355496
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