Boza-Calvo Carolina, Ulate-Aguilar Jose Pablo, Rojas-Salazar Shirley, Roman-Garita Norbel, Masurkar Arjun V
Centro de Investigación en Hematología y Trastornos Afines (CIHATA), University of Costa Rica, San Jose, Costa Rica.
School of Medicine, University of Costa Rica, San Jose, Costa Rica.
J Clin Exp Neuropsychol. 2024 Oct;46(8):755-764. doi: 10.1080/13803395.2024.2411355. Epub 2024 Oct 10.
The burden of Alzheimer's disease and related dementias (AD/ADRD) in Costa Rica is expected to become one of the highest in the region. Early detection will help optimize resources and improve primary care interventions. The Montreal Cognitive Assessment (MoCA) has shown good sensitivity for detecting mild cognitive impairment (MCI), but specificity varies depending on the population. This motivated the analysis of different cutoffs to minimize false-positive classifications in a Costa Rican sample for its use in clinical settings.
Data was analyzed from 516 memory clinic outpatients (148 cognitively normal, 260 MCI, 108 mild AD/ADRD; mean age 66.3 ± 10.8 years) who underwent complete neurological and neuropsychological assessment and were diagnosed by consensus. Optimal MoCA cutoff scores were identified using a multiple cutoff approach.
Overall, a cutoff score of ≥ 23 showed better accuracy to distinguish between normal cognition (NC) and MCI (sensitivity 73%, specificity 83%). When analyzed by educational levels, a cutoff score of ≥ 21 showed better accuracy for ≤ 6 years (sensitivity 80%, specificity 76%), ≥23 for 7-12 years (sensitivity 86%, specificity 76%) and ≥ 24 for > 12 years (sensitivity 70%, specificity 85%). For distinguishing MCI from mild AD/ADRD, the optimal overall cutoff score was ≥ 15 (sensitivity 66%, specificity 85%). When stratified by years of education, cutoff scores of ≥ 14 showed better accuracy for ≤ 6 years (sensitivity 70%, specificity 88%), ≥15 for 7-12 years (sensitivity 46%, specificity 95%) and ≥ 17 for > 12 years (sensitivity 67%, specificity 93%).
A MoCA cutoff score of ≥ 23 in the Costa Rican population showed better diagnostic accuracy for detecting MCI and may reduce the false positive rate. Our findings may be helpful for primary care clinical settings and further referral criteria.
在哥斯达黎加，阿尔茨海默病及相关痴呆症（AD/ADRD）的负担预计将成为该地区最高的之一。早期检测将有助于优化资源并改善初级保健干预措施。蒙特利尔认知评估量表（MoCA）在检测轻度认知障碍（MCI）方面显示出良好的敏感性，但特异性因人群而异。这促使我们分析不同的临界值，以尽量减少哥斯达黎加样本中的假阳性分类，以便用于临床环境。
对516名记忆门诊患者（148名认知正常者、260名MCI患者、108名轻度AD/ADRD患者；平均年龄66.3±10.8岁）的数据进行分析，这些患者接受了全面的神经学和神经心理学评估，并通过共识诊断。使用多重临界值方法确定最佳MoCA临界值分数。
总体而言，临界值分数≥23在区分正常认知（NC）和MCI方面显示出更好的准确性（敏感性73%，特异性83%）。按教育水平分析时，临界值分数≥21在受教育年限≤6年的人群中显示出更好的准确性（敏感性80%，特异性76%），7 - 12年的人群中≥23（敏感性86%，特异性76%），>12年的人群中≥24（敏感性70%，特异性85%）。对于区分MCI和轻度AD/ADRD，最佳总体临界值分数为≥15（敏感性66%，特异性85%）。按教育年限分层时，临界值分数≥14在受教育年限≤6年的人群中显示出更好的准确性（敏感性70%，特异性88%），7 - 12年的人群中≥15（敏感性46%，特异性95%），>12年的人群中≥17（敏感性67%，特异性93%）。
在哥斯达黎加人群中，MoCA临界值分数≥23在检测MCI方面显示出更好的诊断准确性，并可能降低假阳性率。我们的研究结果可能有助于初级保健临床环境及进一步的转诊标准。
