1, 2 The typical profile of cognitive impairment in PD involves impairment in executive functions, attention, visuospatial and subcortical memory functions, recall, language preservation, and praxis. As many as 20-30% of patients with Parkinson’s disease (PD) have cognitive deficits within the range of Mild Cognitive Impairment (MCI) at the time of diagnosis, a condition that is very important to detect since it is associated with an increased risk of developing dementia. Accessed March 27, 2020.Parkinson’s disease (PD) is the second most common neurodegenerative disease after Alzheimer’s disease (AD). Montreal Cognitive Assessment (MoCA) Administration and Scoring Instructions. Study of the slightly modified examination in the diagnosis of cognitive disorders would be valuable regarding its psychometric properties. Given current concerns for infection control, psychiatry needs to play a part, while continuing to provide comprehensive patient care. ![]() A modification of the MoCA by eliminating the visual elements (the five points discussed above, plus naming of three animal pictures) for telephonic administration (yielding 22 net points, with a cutoff of >/= 19) is recommended by the test developers (2). We score the modified test as “modified MoCA” with a denominator of 25, not 30. Since we are eliminating some content from the “MoCA”, our team informally refers to the modified test as a “modified MoCA” or (colloquially and humorously, using coffee shop parlance) the “Latte.” We have not been in a position to study the psychometric properties of this modified examination, but find that this modification enhances infection control while preserving the majority of the utility of this examination. While there admittedly is thus some sacrifice of data pertinent to visual-spatial function, the preservation of the bulk of the test provides important (if somewhat incomplete) clinical information helpful for diagnosis. In light of this concern, when infection control concerns are paramount, our team omits these items and completes the other 25 points (which are accomplished verbally). However, the imperative for cognitive assessment remains, so completely eliminating the test is not desirable. This portion of the test is already problematic for patients with motor deficits and visual impairment, but concerns of infection control make potentially infected patients’ handling of the pen and test paper problematic. However, the top three items on the testing form (trails B, copy of geometrical shape, and clock drawing) require the patient to handle a pen and to touch the test paper. Our consultation-liaison team routinely administers this examination as part of our initial assessments, as we find it very valuable in assessment of delirium, major neurocognitive disorder, and other psychiatric illnesses. The test, instructions for use, one-hour course in administration, supportive references, and multiple versions in many languages are available at The test consists of standardized tests of various cognitive domains and has a maximum score of 30 a score of 26 or more is considered to be in the normal range. ![]() A popular, easy to administer, and validated cognitive assessment is the Montreal Cognitive Assessment (“MoCA”) (1). Yet, the need for full assessment of psychiatry consultation patients remains important, if not accentuated, during times of serious systemic illness in the hospital population. The coronavirus pandemic raises extra concerns about infection control precautions and interpersonal transmission of infectious diseases. ![]() Texas A&M University Health Science CenterĢ401 South 31st Street, Temple TX 76508 USA Chair, Department of Psychiatry, Baylor Scott & White Health, Central Texas DivisionĬlinical Professor (Affiliated), College of Medicine,
0 Comments
Leave a Reply. |