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.