The MoCA and MMSE as screeners for cognitive impairment in a heart failure population: A study with comprehensive neuropsychological testing

Objective: To examine the ability of the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to detect cognitive impairment in persons with heart failure (HF). Background: Although the MMSE and MoCA are commonly used screeners in HF, no research team has validated their performance against neuropsychological testing. Methods: Participants were 106 patients with HF (49.1% male, 68.13±9.82 years) who completed the MoCA, MMSE, and a full neuropsychological battery. Sensitivity and specificity were examined. Discriminant function analyses tested whether the screeners correctly detected cognitive impairment. Results: A MoCA score <25 and MMSE score of <28 yielded optimal sensitivity/specificity (.64/.66 and .70/.66, respectively). The MoCA correctly classified 65% of patients, Wilk's lambda=.91, χ²(1)=9.89, p<.01, and the MMSE correctly classified 68%, Wilk's lambda=.87, χ²(1)=14.26, p<.001. Conclusions: In HF, both the MoCA and MMSE are useful in identifying the majority of patients with and without cognitive impairment. Both tests misclassified approximately one-third of patients, so continued monitoring and evaluation of patients is needed in conjunction with screening.