![]() ![]() Lin et al developed a computerised visual version of the MoCA with verbal instructions converted into visual instructions. There have been two previous attempts to adapt the MoCA for people with hearing impairment. The MoCA has previously been validated in populations with vascular dementia, frontotemporal dementia, 12 Parkinson’s disease 13 and Alzheimer’s disease (AD) 14 and has good sensitivity and specificity for the detection of both dementia and mild cognitive impairment (MCI). Administration time is usually less than 20 min. The MoCA consists of a single page, 30-item test that measures abilities in eight domains: visuospatial/executive, naming, memory, attention, language, abstraction, delayed recall and orientation. 11 The MoCA is a widely used screening measure that is available free of charge and has been translated into 55 different languages. To address the need for reliable screening measures of cognitive function for people with acquired sensory impairment, we propose to develop and validate versions of the Montreal Cognitive Assessment (MoCA). 10 Unfortunately, deletion of hearing-dependent or vision-dependent items may adversely impact sensitivity and specificity of the adapted tests. Previous attempts to adapt cognitive tests for people with sensory impairment involved deleting or substituting written versions of hearing-dependent items and deleting or substituting spoken or tactile versions of vision-dependent items. In two UK studies, hearing impairment was identified in 94% of people with a cognitive impairment attending a memory clinic 8 and a national survey identified visual impairment (visual acuity worse than 6/12) in 32.5% of a sample of people with dementia. 7 Hearing and vision impairment commonly co-occur with cognitive impairment in older adults. 1–6 The confounding of cognitive tests by hearing or vision impairment may lead to false positive identification of cognitive impairment and/or over-estimation of the severity of cognitive impairment. People with hearing or visual impairment and simulated hearing or vision impairment perform more poorly on tests of cognition than those with normal sensory function. Loss of the ability to group words into subsets (e.g.Commonly used tests for cognitive impairment mostly consist of items presented in the visual and/or auditory modality and rely on good sensory function.36-point total score, 12-point recognition score.Biased against visually impaired and poorly educated.Not as useful or sensitive as MMSE or MOCA for initial diagnosis.Pattern of scoring correlates well with – and hence helps determine – the clinical type of dementia.Correlates well with severity of dementia as seen in poor MMSE scores.Associated score then calculated by the assessor.Set the hands and numbers on the face so that a child could read them. Instruct the patient to draw a clock that says 1:45.Designed to elicit executive impairment.Though different suggestive cut-offs for those disadvantaged are available, they are not validated.Still has some bias against people with poor education.More sensitive at detection of mild dementia (100% sensitivity in some studies).More complete assessment of all aspects of cognition, including visuospacial, attention, word-finding.Montreal Cognitive Assessment (MoCA) – click here Copyrighted and should officially only be accessed via the Psychological Assessment Resourcing (PAR).Poor sensitivity at detected mild/early dementia.Limited examination of visuospacial cognitive ability.Biased against people with poor education due to elements of language and mathematical testing.Can provide a method of monitoring deterioration over time.Mini Mental State Exam (MMSE) – click here The following are some of the most common tests utilised, but is by no means an exhaustive list. They all have advantages and disadvantages so the best test should be decided on a case-by-case basis, depending on what additional information one hopes to gain. There are a variety of different cognitive function tests that have been designed and validated to help diagnose and subtype dementia. ![]()
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