In response to the increase in dementia prevalence and difficulties in working beyond retirement age, early retirement requests have risen. An additional concern is the expected increase in neurodegenerative diseases, considering age is the biggest risk factor for dementia ( Alzheimer’s Society, 2016).ĭementia is a progressive pathology associated with aging in which one or more cognitive functions decline from a previous level of functioning beyond what is expected for their age and education ( American Psychiatric Association, 2013), compromising autonomy in Activities of Daily Living. Several critical implications have emerged from this “longevity revolution.” Among them, there is a growing concern for adjusting national social policies related to retirement age, as has happened in Portugal in recent years ( Decreto-Lei n.º 119/2018 de 27 de Dezembro do Ministério do Trabalho, Solidariedade e Segurança Social, 2018). By 2050, it is estimated that 1 in every six individuals will be older than 65, a stark increase from the 2019 estimate of 1 in 11 ( United Nations, 2019). We are currently witnessing the progressive aging of the world population. These results present important implications for clinical practice and the daily life of patients, as the use of incorrect cut-off points could impede patients from getting the resources they need. Additionally, the Rey-15 Item Memory Test did not demonstrate sufficient discriminating capacity for dementia. The results showed that (1) all measures, except for the Coin in Hand- Extended version (CIH-EV), were sensitive to one or more sociodemographic and/or cognitive variables, and (2) it was necessary to adjust cut-off points for all measures. Further, we examined the potential need for adjusting cut-off scores for three stand-alone (Test of Memory Malingering, Rey-15 Item Memory Test, and Coin in Hand-Extended Version) and one embedded (Reliable Digit Span) PVT for Portuguese older adults with dementia. Here, we analyzed the sensitivity of PVTs in discriminating between dementia and simulation using receiver operating characteristic (ROC) curve analyses. Previous research demonstrates that PVTs may be sensitive to dementia, thus inaccurately classifying real memory impairment as simulation. Performance Validity Tests (PVTs) are specifically designed to assess a lack of effort and the possible simulation of cognitive impairment. In order to ensure the proper allocation of care and resources to this clinical group, it is necessary to correctly distinguish between simulated versus bona-fide cognitive deficits typical of dementia. The rising demographic of older adults worldwide has led to an increase in dementia cases. 4Psychology Department, Campus Duques de Soria, University of Valladolid, Valladolid, Spain.3Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal.2CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal.1Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal.Mild Cognitive Impairment MoCA Montreal Cognitive Assessment cutoff scores diagnostic accuracy.Sandra Fernandes 1,2 * † Inês Ferreira 1 † Luís Querido 1,3 Julia C. We recommend the use of this cutoff score going forward. Meta-analysis revealed a cutoff score of 23/30 yielded the best diagnostic accuracy across a range of parameters.Ī MoCA cutoff score of 23, rather than the initially recommended score of 26, lowers the false positive rate and shows overall better diagnostic accuracy. These studies were assessed across a range of cutoff scores to determine the respective sensitivities, specificities, positive and negative predictive accuracies, likelihood ratios for positive and negative results, classification accuracies, and Youden indices. Of the 304 studies identified, nine met inclusion criteria for the meta-analysis. We conducted a systematic review and meta-analysis of the literature to determine the diagnostic accuracy of the MoCA for differentiating healthy cognitive aging from possible MCI. Some studies have indicated that the originally suggested cutoff score of 26/30 leads to an inflated rate of false positives, particularly for those of older age and/or lower education. Several validation studies have been conducted on the MoCA, in a variety of clinical populations. The Montreal Cognitive Assessment (MoCA Nasreddine et al., 2005) is a cognitive screening tool that aims to differentiate healthy cognitive aging from Mild Cognitive Impairment (MCI).
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