Validity of Montreal Cognitive Assessment to Detect Cognitive Impairment in Individuals with Type 2 Diabetes.

IF 3.8 3区 医学 Q2 Medicine
Diabetes Therapy Pub Date : 2024-05-01 Epub Date: 2024-03-23 DOI:10.1007/s13300-024-01549-y
Anu Gupta, Alpesh Goyal, Roopa Rajan, Venugopalan Y Vishnu, Mani Kalaivani, Nikhil Tandon, Madakasira V P Srivastava, Yashdeep Gupta
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Abstract

Introduction: Guidelines recommend screening older people (> 60-65 years) with type 2 diabetes (T2D) for cognitive impairment, as it has implications in the management of diabetes. The Montreal Cognitive Assessment (MoCA) is a sensitive test for the detection of mild cognitive impairment (MCI) in the general population, but its validity in T2D has not been established.

Methods: We administered MoCA to patients with T2D (age ≥ 60 years) and controls (no T2D), along with a culturally validated neuropsychological battery and functional activity questionnaire. MCI was defined as performance in one or more cognitive domains ≥ 1.0 SD below the control group (on two tests representing a cognitive domain), with preserved functional activities. The discriminant validity of MoCA for the diagnosis of MCI at different cut-offs was ascertained.

Results: We enrolled 267 patients with T2D and 120 controls; 39% of the participants with T2D met the diagnostic criteria for MCI on detailed neuropsychological testing. At the recommended cut-off on MoCA (< 26), the sensitivity (94.2%) was high, but the specificity was quite low (29.5%). The cut-off score of < 23 showed an optimal trade-off between sensitivity (69.2%), specificity (71.8%), and diagnostic accuracy (70.8%). The cut-off of < 21 exhibited the highest diagnostic accuracy (74.9%) with an excellent specificity (91.4%), a good positive and negative predictive value (78.5% and 73.7%, respectively).

Conclusions: The recommended screening cut-off point on MoCA of < 26 has a suboptimal specificity and may increase the referral burden in memory clinics. A lower cut-off of < 21 on MoCA maximizes the diagnostic accuracy. Interactive Visual Abstract available for this article.

Abstract Image

蒙特利尔认知评估检测 2 型糖尿病患者认知功能障碍的有效性。
导言:指南建议对患有 2 型糖尿病(T2D)的老年人(大于 60-65 岁)进行认知障碍筛查,因为这对糖尿病的管理有影响。蒙特利尔认知评估(MoCA)是检测普通人群轻度认知障碍(MCI)的灵敏测试,但其在 T2D 中的有效性尚未确定:我们对 T2D 患者(年龄≥ 60 岁)和对照组(无 T2D)进行了 MoCA 测试,同时还进行了经文化验证的神经心理测试和功能活动问卷调查。MCI 的定义是在一个或多个认知领域的表现比对照组低≥ 1.0 SD(在代表一个认知领域的两项测试中),但功能活动保持不变。我们确定了不同临界值的MoCA对MCI诊断的判别有效性:我们招募了 267 名 T2D 患者和 120 名对照组患者,其中 39% 的 T2D 患者在详细的神经心理学测试中符合 MCI 诊断标准。在MoCA的推荐临界点(结论:MoCA的推荐筛查临界点是在MoCA的临界点上:MoCA的推荐筛查临界点为
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来源期刊
Diabetes Therapy
Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.90
自引率
7.90%
发文量
130
审稿时长
6 weeks
期刊介绍: Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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