A comparison of the Montreal Cognitive Assessment (MoCA) to the revised Addenbrooke Cognitive Examination (ACE-R) for the screening of Mild Cognitive Impairment

Sjostedt, Jennifer Marie

Sunday, 17 November 2013: 3:25 PM

Jennifer Marie Sjostedt, RN, MSN
Marquette University, Milwaukee, WI
Robert Topp, RN, PhD
College of Nursing, Marquette University, Milwaukee, WI
Piero G Antuono, MD
Medical College Wisconsin, Milwaukee, WI
Malgorzata B Franczak, MD
Department of Neurology, Medical College of Wisconsin, Milwaukee, WI

Learning Objective 1: Learners will be able to compare and contrast two screening instruments (ACE-R and MoCA) for mild cognitive impairment (MCI).

Learning Objective 2: Learners will be able to choose the appropriate screening instrument for MCI within their practice setting.

Identification of mild cognitive impairment (MCI) begins with cognitive screening. Currently there is not a gold standard for measuring cognitive impairment; historically, tools for dementia screening were used (i.e. the MMSE). Such screening tools are insensitive to subtle changes in cognition associated with MCI. Purpose of this study is to compare the reliability/validity of two cognitive screening tools for persons with MCI: the Montreal Cognitive Assessment (MoCA) and revised Addenbrooke Cognitive Exam (ACE-R).

Subjects had MCI, were >54 years old, and could speak/write in English. After their clinic appointment with administration of the ACE-R, subjects completed portions of the MoCA. Portions excluded were items also on the ACE-R: cube-copy, clock-draw, serial 7’s, and orientation (i.e. date, place). These portions were then rescored to create complete MoCA scores. MMSE scores were also calculated from the ACE-R for further comparisons.

Results: 98% (n = 49) of the sample completed some education beyond high school. Scores ranged from 57-94 (ACE-R) and 14-28 (MoCA). Cronbach’s alpha indicated acceptable internal consistency (0.68 ACE-R, 0.64 MoCA). Pearson’s correlation was significant between the ACE-R and MoCA (0.80, p < 0.001). 68% (n = 34) screened within normal range on the MMSE. Comparatively, 20% (n = 10) screened within normal range on the MoCA (n = 2), ACE-R (n = 5), or both tests (n = 3). Of those, 90% were male, 100% had normal MMSE scores, and 100% were college educated.

Both instruments appear to be reliable/valid tools for the screening of MCI in a highly educated sample. As most primary care settings use the MMSE for cognitive screening, this study’s recommendation is to instead use the MoCA as it appears to be more sensitive for MCI and contains fewer items than the ACE-R. Results may have been affected by test order, sample size, and educational level.

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