Comparison of the Short Test of Mental Status and the Montreal Cognitive Assessment Across the Cognitive Spectrum

Abstract

Mayo Clin Proc. 2019;94(8):1516-1523 Abbreviations and Acronyms: AD = Alzheimer disease; ADRC = Alzheimer's Disease Research Center; AUC = area under the curve; CN = cognitively normal; DLB = dementia with Lewy bodies; FTLD = frontotemporal lobar dementia; MCI = mild cognitive impairment; MCSA = Mayo Clinic Study of Aging; MMSE = Mini-Mental State Examination; M°CA = Montreal Cognitive Assessment; STMS = Short Test of Mental Status Bedside cognitive tests performed by primary care and neurology providers are an important screening tool for mild cognitive impairment (MCI) and dementia. A variety of tests are being used in clinics across the world, but few have been validated in community settings.3 Most of the existing tools are biased toward detection of amnestic-predominant cognitive impairment, with less emphasis on other cognitive domains frequently involved in frontotemporal lobar dementia (FTLD) or dementia with Lewy bodies (DLB).4 The Mini-Mental State Examination (MMSE) is widely used and can be administered relatively quickly, but MMSE scores are not useful for diagnosing MCI,5'6 and its licensing fee has made this measure less attractive for clinical use.7'8 The Montreal Cognitive Assessment (M°CA) was created specifically to improve the diagnosis of MCI and has reported improved sensitivity in head-to-head studies with the MMSE in a variety of cognitive impairment settings.5'9-11 The proposed cutoff score of 26 has been considered too sensitive in some studies' limiting the specificity of an abnormal score.12'13 The Short Test of Mental Status (STMS) was developed and validated as a bedside tool that emphasizes brevity and reasonable sensitivity and specificity. Study participants were recruited prospectively through the Mayo Clinic Study of Aging (MCSA) and the Mayo Clinic Alzheimer's Disease Research Center (ADRC) using a standardized protocol.16'17 With the help of the Rochester Epidemiology Project, MCSA participants were randomly selected from a community population of Olmsted County, Minnesota, from November 24, 2010, through May 19, 20 1 2.18-20 Participants from the Mayo Clinic ADRC (March 16, 2015, through September 5, 2018) represent a nonrandom sample that is geographically and clinically diverse. [...]to create conversion tables between the STMS and the M°CA, equipercentile equating was used.