Skip to main content

Advertisement

SpringerLink
Log in

Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy

  • Neurology and Preclinical Neurological Studies - Original Article
  • Published:
Journal of Neural Transmission Aims and scope Submit manuscript

Abstract

To determine if Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting cognitive abnormalities in patients with probable progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) compared with Parkinson’s disease (PD). In this multicenter observational study, MMSE and MoCA were administered in a random order to 130 patients: 35 MSA, 30 PSP and 65 age, and education and gender matched-PD. We assessed between-group differences for MMSE, MoCA, and their subitems. Receiver-operating characteristic (ROC) curves were calculated. The mean MMSE was higher than the mean MoCA score in each MSA (27.7 ± 2.4 vs. 22.9 ± 3.0, p < 0.0001), PSP (26.0 ± 2.9 vs. 18.2 ± 3.9, p < 0.0001), and PD (27.3 ± 2.0 vs. 22.3 ± 3.5, p < 0.0001). MoCA total score as well as its letter fluency subitem differentiated PSP from MSA and PD with high specificity and moderate sensitivity. More specifically, a cut-off score of 7 F-words or less per minute would support a diagnosis of PSP (PSP vs. PD: 86 % specificity, 70 % sensitivity; PSP vs. MSA: 71 % specificity, 70 % sensitivity). By contrast, MMSE presented an overall ceiling effect for most subitems, except for the pentagon scores, where PSP did less well than MSA or PD patients. These preliminary results suggest that PSP and MSA, similar to PD patients, may present normal MMSE and reduced MoCA performance. Overall, MoCA is more sensitive than MMSE in detecting cognitive impairment in atypical parkinsonism and together with verbal fluency would be a useful test to support PSP diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Aarsland D, Litvan I, Salmon D, Galasko D, Wentzel-Larsen T, Larsen JP (2003) Performance on the dementia rating scale in Parkinson’s disease with dementia and dementia with Lewy bodies: comparison with progressive supranuclear palsy and Alzheimer’s disease. J Neurol Neurosurg Psychiatry 74:1215–1220

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Auzou N, Dujardin K, Biundo R, Foubert-Samier A, Barth C, Duval F, Tison F, Defebvre L, Antonini A, Meissner WG (2015) Diagnosing dementia in multiple system atrophy by applying Movement Disorder Society diagnostic criteria for Parkinson’s disease dementia. Parkinsonism Relat Disord 21:1273–1277

    Article  PubMed  Google Scholar 

  • Bak TH, Crawford LM, Hearn VC, Mathuranath PS, Hodges JR (2005a) Subcortical dementia revisited: similarities and differences in cognitive function between progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and multiple system atrophy (MSA). Neurocase 11:268–273

    Article  CAS  PubMed  Google Scholar 

  • Bak TH, Rogers TT, Crawford LM, Hearn VC, Mathuranath PS, Hodges JR (2005b) Cognitive bedside assessment in atypical parkinsonian syndromes. J Neurol Neurosurg Psychiatry 76:420–422

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bak TH, Caine D, Hearn VC, Hodges JR (2006) Visuospatial functions in atypical parkinsonian syndromes. J Neurol Neurosurg Psychiatry 77:454–456

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Biundo R, Weis L, Bostantjopoulou S, Stefanova E, Falup-Pecurariu C, Kramberger MG, Geurtsen GJ, Antonini A, Weintraub D, Aarsland D (2016) MMSE and MoCA in Parkinson’s disease and dementia with Lewy bodies: a multicenter 1-year follow-up study. J Neural Transm (Vienna) 123:431–438

    Article  CAS  Google Scholar 

  • Borroni B, Turla M, Bertasi V, Agosti C, Gilberti N, Padovani A (2008) Cognitive and behavioral assessment in the early stages of neurodegenerative extrapyramidal syndromes. Arch Gerontol Geriatr 47:53–61

    Article  CAS  PubMed  Google Scholar 

  • Brown RG, Lacomblez L, Landwehrmeyer BG, Bak T, Uttner I, Dubois B, Agid Y, Ludolph A, Bensimon G, Payan C, Leigh NP, NNIPPS Study Group (2010) Cognitive impairment in patients with multiple system atrophy and progressive supranuclear palsy. Brain 133:2382–2393

    Article  PubMed  Google Scholar 

  • Burrell JR, Hodges JR, Rowe JB (2014) Cognition in corticobasal syndrome and progressive supranuclear palsy: a review. Mov Disord 29:684–693

    Article  PubMed  Google Scholar 

  • Cordato NJ, Halliday GM, Caine D, Morris JG (2006) Comparison of motor, cognitive, and behavioral features in progressive supranuclear palsy and Parkinson’s disease. Mov Disord 21:632–638

    Article  PubMed  Google Scholar 

  • DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 3:837

    Article  Google Scholar 

  • Dujardin K, Defebvre L, Krystkowiak P, Degreef JF, Destee A (2003) Executive function differences in multiple system atrophy and Parkinson’s disease. Parkinsonism Relat Disord 9:205–211

    Article  PubMed  Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  • Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56:33

    Article  CAS  PubMed  Google Scholar 

  • Gill DJ, Freshman A, Blender JA, Ravina B (2008) The Montreal Cognitive Assessment as a screening tool for cognitive impairment in Parkinson’s disease. Mov Disord 23:1043–1046

    Article  PubMed  Google Scholar 

  • Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, Wood NW, Colosimo C, Durr A, Fowler CJ, Kaufmann H, Klockgether T, Lees A, Poewe W, Quinn N, Revesz T, Robertson D, Sandroni P, Seppi K, Vidailhet M (2008) Second consensus statement on the diagnosis of multiple system atrophy. Neurology 71:670–676

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Henry JD, Crawford JR (2004) A meta-analytic review of verbal fluency performance following focal cortical lesions. Neuropsychology 18:284–295

    Article  PubMed  Google Scholar 

  • Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB, Weintraub D (2009) Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology 73:1738–1745

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Koziol LF, Budding DE (2009) Subcortical structures and cognition. Implications for neuropsychological assessment. Springer, New York

    Book  Google Scholar 

  • Lagarde J, Valabregue R, Corvol JC, Pineau F, Le Ber I, Vidailhet M, Dubois B, Levy R (2013) Are frontal cognitive and atrophy patterns different in PSP and bvFTD? A comparative neuropsychological and VBM study. PLoS One 8:e80353

    Article  PubMed  PubMed Central  Google Scholar 

  • Lange KW, Tucha O, Alders GL, Preier M, Csoti I, Merz B, Mark G, Herting B, Fornadi F, Reichmann H, Vieregge P, Reiners K, Becker G, Naumann M (2003) Differentiation of parkinsonian syndromes according to differences in executive functions. J Neural Transm (Vienna) 110:983–995

    Article  CAS  Google Scholar 

  • Lee W, Williams DR, Storey E (2012) Cognitive testing in the diagnosis of parkinsonian disorders: a critical appraisal of the literature. Mov Disord 27:1243–1254

    Article  PubMed  Google Scholar 

  • Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC, Goetz CG, Golbe LI, Grafman J, Growdon JH, Hallett M, Jankovic J, Quinn NP, Tolosa E, Zee DS (1996) Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele–Richardson–Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology 47:1–9

    Article  CAS  PubMed  Google Scholar 

  • Luis CA, Keegan AP, Mullan M (2009) Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry 24:197–201

    Article  PubMed  Google Scholar 

  • Meco G, Gasparini M, Doricchi F (1996) Attentional functions in multiple system atrophy and Parkinson’s disease. J Neurol Neurosurg Psychiatry 60:393–398

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699

    Article  PubMed  Google Scholar 

  • Paviour DC, Winterburn D, Simmonds S, Burgess G, Wilkinson L, Fox NC, Lees AJ, Jahanshahi M (2005) Can the frontal assessment battery (FAB) differentiate bradykinetic rigid syndromes? Relation of the FAB to formal neuropsychological testing. Neurocase 11:274–282

    Article  CAS  PubMed  Google Scholar 

  • Pillon B, Gouider-Khouja N, Deweer B, Vidailhet M, Malapani C, Dubois B, Agid Y (1995) Neuropsychological pattern of striatonigral degeneration: comparison with Parkinson’s disease and progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 58:174–179

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rittman T, Ghosh BC, McColgan P, Breen DP, Evans J, Williams-Gray CH, Barker RA, Rowe JB (2013) The Addenbrooke’s Cognitive Examination for the differential diagnosis and longitudinal assessment of patients with parkinsonian disorders. J Neurol Neurosurg Psychiatry 84:544–551

    Article  PubMed  PubMed Central  Google Scholar 

  • Siri C, Duerr S, Canesi M, Delazer M, Esselink R, Bloem BR, Gurevich T, Balas M, Giladi N, Santacruz P, Marti F, Tolosa E, Rubino A, Meco G, Poewe W, Pezzoli G, Wenning G, Antonini A (2013) A cross-sectional multicenter study of cognitive and behavioural features in multiple system atrophy patients of the parkinsonian and cerebellar type. J Neural Transm 120:613–618

    Article  CAS  PubMed  Google Scholar 

  • Soliveri P (2000) Neuropsychological follow up in patients with Parkinson’s disease, striatonigral degeneration-type multisystem atrophy, and progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 69:313–318

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stamelou M, Diehl-Schmid J, Hapfelmeier A, Kontaxopoulou D, Stefanis L, Oertel WH, Bhatia KP, Papageorgiou SG, Hoglinger GU (2015) The frontal assessment battery is not useful to discriminate progressive supranuclear palsy from frontotemporal dementias. Parkinsonism Relat Disord 21:1264–1268

    Article  CAS  PubMed  Google Scholar 

  • Stuss DT, Alexander MP, Hamer L, Palumbo C, Dempster R, Binns M, Levine B, Izukawa D (1998) The effects of focal anterior and posterior brain lesions on verbal fluency. J Int Neuropsychol Soc 4:265–278

    CAS  PubMed  Google Scholar 

  • Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 25:2649–2653

    Article  PubMed  Google Scholar 

  • Videnovic A, Bernard B, Fan W, Jaglin J, Leurgans S, Shannon KM (2010) The Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in Huntington’s disease. Mov Disord 25:401–404

    Article  PubMed  Google Scholar 

  • Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35

    Article  CAS  PubMed  Google Scholar 

  • Zadikoff C, Fox SH, Tang-Wai DF, Thomsen T, de Bie RM, Wadia P, Miyasaki J, Duff-Canning S, Lang AE, Marras C (2008) A comparison of the mini mental state exam to the Montreal Cognitive Assessment in identifying cognitive deficits in Parkinson’s disease. Mov Disord 23:297–299

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank our patients for supporting this research.

Author information

Authors and Affiliations

  1. Parkinson’s Disease and Movement Disorders Unit, “Fondazione Ospedale San Camillo”-I.R.C.C.S., Via Alberoni, 70, 30126, Venice-Lido, Italy

    Eleonora Fiorenzato, Luca Weis, Angelo Antonini & Roberta Biundo

  2. Department of General Psychology, University of Padua, Padua, Italy

    Eleonora Fiorenzato & Patrizia Bisiacchi

  3. Faculty of Medicine, Transilvania University, Brasov, Romania

    Cristian Falup-Pecurariu

  4. Department of Neurology, County Emergency Clinic Hospital, Brasov, Romania

    Cristian Falup-Pecurariu & Stefania Diaconu

  5. Parkinson Institute, ASST G. Pini-CTO, ex ICP, Milan, Italy

    Chiara Siri, Elisa Reali & Gianni Pezzoli

  6. Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy

    Chiara Siri & Elisa Reali

Authors
  1. Eleonora Fiorenzato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luca Weis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cristian Falup-Pecurariu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefania Diaconu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chiara Siri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elisa Reali
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gianni Pezzoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Patrizia Bisiacchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Angelo Antonini
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Roberta Biundo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eleonora Fiorenzato.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Venice Research Ethics Committee (Venice, IT) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors have no competing interest to declare.

Funding

None.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 83 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fiorenzato, E., Weis, L., Falup-Pecurariu, C. et al. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy. J Neural Transm 123, 1435–1442 (2016). https://doi.org/10.1007/s00702-016-1589-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00702-016-1589-3

Keywords

Search

Navigation