Brevity vs. Breadth: Can Memory Disorders Be Diagnosed Using Fewer Neuropsychological Assessments?
Abstract
Object: The present study examines the clinical utility of combining a cognitive
screener, Montreal Cognitive Assessment (MoCA), with a measure of adaptive
functioning, Texas Functional Living Scale (TFLS), to diagnose memory disorders
when differentiating between cognition within normal limits (WNL), mild
cognitive impairment (MCI), and Alzheimer’s disease (AD).
Method: A total of 207 Health First Memory Disorder Clinic patients, ages 64-94,
were included in the study. Participants were screened using the MoCA and then
they completed a brief neuropsychological evaluation, which included the TFLS.
Participants were only included if they received a diagnosis of cognition WNL,
MCI, or AD. They also had to meet criteria for each MoCA total and TFLS T-score
cut-off for each diagnostic category (WNL: MoCA = ≥ 26, TFLS T = ≥ 44, MCI:
MoCA = 19-25, TFLS T = 37-43, AD: MoCA ≤ 18, TFLS T = ≤36).
Results: Results of the present study revealed that the combined MoCA and TFLS
score had statistically significant amount of agreement based on a chi-square
analysis when compared to the overall diagnosis as determined by the Brief
Neuropsychological Evaluation (BNE). Additionally, the MoCA and TFLS
combined score was a statistically significant predictor of the diagnostic outcome.
Correlational analysis revealed that the diagnosis based on the MoCA + TFLS
combination score had a statistically significant moderate positive relationship with
the diagnosis based on the BNE. Furthermore, the TFLS subtest that had the
strongest relationship with a diagnosis of AD was the Memory subtest.
Conclusion: When differentiating between patients who have a diagnosis of
cognition WNL, MCI, and AD, the MoCA and TFLS alone can give us similar
information as a full battery of testing (BNE). Therefore, if this is used as an
alternative mode of testing, more patients can be tested in a day, thereby reducing
wait time between the initial visit and the cognitive evaluation, as well as
diminishing the waitlist. As a result, diagnoses of mild cognitive impairment or
Alzheimer’s disease can be detected earlier, and appropriate interventions can be
introduced sooner.