非痴呆帕金森病患者认知功能状态分析

目的 分析非痴呆帕金森病(PD)患者认知功能的特点及其影响因素,为早期诊断和干预PD认知功能损害提供依据. 方法 选择广州军区广州总医院神经内科自2010年1月至201 1年10月收治的PD患者56例,采用简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评定其认知功能,Logistic逐步回归分析PD患者认知功能损害的影响因素. 结果 以MMSE为评估标准时,6例(7.14％)PD患者存在轻度认知功能损害(MCI);而以MoCA为标准时,40例(71.43％)PD患者存在MCI.MMSE和MoCA评分均与患者文化程度呈正相关关系(r=0.483,P=0.007;r=0.503,P=0.000).MMSE各认知域中评分下降幅度较大的是视空间、计算及注意力、复述和延迟记忆.认知域评分低于相应认知域总分患者例数较多的为延迟记忆、视空间、即刻记忆和复述.MoCA各认知域评分下降幅度较大的为复述、延迟记忆、抽象、视空间与执行;认知域评分低于相应认知域总分患者例数较多的为延迟记忆、复述、注意和视空间与执行.Logistic逐步回归分析显示文化程度和临床分型是影响PD认知功能损害的主要因素,即文化程度较低,少动强直型和混合型的PD患者认知功能损害风险增高. 结论 认知功能损害在PD患者中常见,以延迟记忆、视空间与执行、计算及注意力、抽象和复述等认知域为主.文化程度和临床分型是PD认知功能损害的主要影响因素.     

蒙特利尔认知评估量表在轻度认知功能障碍筛查中的应用

目的 探讨蒙特利尔认知评估量表(MoCA)在轻度认知功能障碍(MCI)患者筛查中的应用.方法 应用简易精神状态检查量表(MMSE)、MoCA对32例MCI患者和50例健康对照者进行神经心理评估,比较二者筛查MCI的效果.结果 以26分为分界值,MoCA筛查MCI的敏感性为96.87%、特异性为76%,MMSE筛查MCI的敏感性为56.25%、特异性为96%;MoCA中除抽象思维、地点定向两项外,其余各亚项的评分在MCI组和对照组间差异均有统计学意义(P＜0.05):MMSE中仅计算与注意力、延迟回忆两项在MCI组和对照组间差异有统计学意义(P＜0.05),其余各项差异均无统计学意义(P＞0.05).结论 MoCA为高敏感性的MCI筛查工具,能全面评估MCI患者的认知功能.且可用于筛查MMSE得分正常的MCI患者.     

重症肌无力患者认知功能研究

目的分析MG患者认知功能特点及与患者乙酰胆碱受体抗体(AChRAb)、病情分型的相关性。方法对37例MG患者和25例疾病对照组进行焦虑自评量表(SAS)、抑郁自评量表(SDS)评估排除明显焦虑、抑郁后;使用蒙特利尔认知评估量表(MoCA)、简易精神状态评估量表(MMSE)评估认知功能,分析MG患者认知功能特点。结果 (1)研究组37例MG患者有14例(37. 839%)存在MoCA评分达到认知功能受损,2例(5. 714%)MMSE评估为轻度认知功能障碍(MCI);(2)研究组MoCA、MMSE各认知项目评估结果显示延迟回忆、视空间与执行功能、注意力和计算力成绩有明显下降,语言和定向能力保留较完整;(3) AChRAb阳性型MG患者MoCA总得分、MoCA视空间执行功能项目得分比AChRAb阴性MG患者低。结论 MG患者MoCA、MMSE评定结果存在多个认知项目成绩下降,但总体成绩与对照组相比无统计学差异,说明MG患者可能存在认知功能下降,但程度较轻。MG患者认知功能变化特点是可能存在延迟回忆、视空间与执行功能、注意力计算力下降,语言和定向能力保留较完整。AChRAb阳性MG患者MoCA认知测试成绩较AChRAb阴性MG患者差,提示MG患者认知功能的下降可能与血清AChRAb对CNS免疫攻击作用有关。     

轻度认知功能障碍患者的日常生活能力改变

目的分析轻度认知功能障碍(MCI)患者的日常生活能力的改变情况。方法研究对象为50岁以上患者,根据欧洲AD协会MCI工作组于2005年提出的MCI诊断标准诊断轻度认知功能障碍(MCI)41例,对照(NC)34例,进行蒙特利尔认知评定量表(MoCA)、日常生活活动能力量表(ADL)测试。结果 41例MCI中有8例日常生活活动能力下降,MoCA、MoCA-mem与ADL得分有相关性[相关系数分别为-0.29,P<0.05(P=0.01)、-0.27,P<0.05(P=0.02)];MCI组与NC组在工具性日常生活活动量表(IADL)得分上差异明显[P=0.02(P<0.05)],在ADL得分及躯体生活自理量表(PSMS)得分上差异不明显,(P分别为0.09、0.75)。MCI组PSMS损害程度与IADL损害程度之间的差异明显[P=0.03(P<0.05)]。结论部分轻度认知功能损害患者存在日常生活活动能力的轻微下降,以IADL下降为主。     

轻度认知损害患者脑血流动力学与认知功能相关分析

目的探讨轻度认知损害(MCI)患者脑血流动力学特点及其与认知功能的相关性。方法采用简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(MoCA)评价40例轻度认知损害患者及性别和年龄相匹配的40例正常对照者的认知功能,经颅多普勒超声检测双侧大脑中动脉和基底动脉平均血流速度、搏动指数、阻力指数、收缩期峰值流速与舒张末期流速比值。结果 MCI组患者大脑中动脉搏动指数(P=0.023)和阻力指数(P=0.035)高于对照组,而平均血流速度和收缩期峰值流速与舒张末期流速比值以及基底动脉各项血流动力学指标差异均无统计学意义(P0.05)。MCI组患者大脑中动脉搏动指数异常率高于对照组[45%(18/40)对20%(8/40);χ~2=4.615,P=0.032]。Pearson相关分析显示,MCI组大脑中动脉搏动指数与MoCA评分呈负相关(r=-0.382,P=0.036),与MMSE评分无关联性(P0.05);而平均血流速度、阻力指数和收缩期峰值流速与舒张末期流速比值以及基底动脉各项血流动力学指标与MMSE和Mo CA评分均无关联性(P0.05)。根据搏动指数将轻度认知损害患者进一步分组,搏动指数异常亚组MoCA评分低于搏动指数正常亚组[(18.57±3.02)分对(23.41±2.78)分;t=3.914,P=0.015]。结论轻度认知损害患者存在脑血流动力学改变,尤以大脑中动脉搏动指数升高与认知功能障碍的关系最为密切。     

轻度认知障碍和阿尔茨海默病患者认知功能和MRI对照研究

目的探讨轻度认知障碍（MCI）和阿尔茨海默病（AD）的认知功能及影像学特点。方法回顾性分析经临床确诊的21例MCI和24例AD患者的临床资料。所有实验对象均用简易智力量表（MMSE）和蒙特利尔认知评估（MoCA）测定。结果MCI与AD的认知功能损害相比较：除了MMSE的记忆力组间无统计学意义（P＝0．28）,其余均有统计学差异（P〈0．05）。MoCA比MMSE具有更好的敏感性。AD的MRI表现：脑萎缩,特别是海马存在不同程度的萎缩;老年性脑改变;MCI的MRI主要表现为脑白质脱髓鞘病变,少数提示轻度脑萎缩或未见明显异常。结论MCI和AD患者早期均表现为记忆力下降,对记忆力减退人群进行MMSE、MoCA量表筛查有助于AD的早期诊断。AD患者到中晚期治疗较困难,因此早期诊断及干预对延缓病程起积极作用。     

蒙特利尔认知评估量表在轻度认知功能障碍中的应用

目的探讨蒙特利尔认知评估量表在轻度认知功能障碍患者中的应用。方法测试年龄及教育程度相匹配的42例MCI患者及39例正常对照组进行MoCA测查。结果与对照组（27.36±1.38）相比,MCI组的MoCA总分（23.93±3.69）更差,差异有统计学意义（P〈0.01）;MCI组在命名、语言及定向方面与对照组无明显差异（P〉0.05）。MCI组在视空间与执行功能（HC 4.46±0.78,MCI 3.57±1.23）、注意（HC 5.95±0.22,MCI 5.61±0.73）、抽象思维（HC 1.61±0.54,MCI1.21±0.68）及延迟回忆（HC 3.54±0.88,MCI 1.97±1.20）方面,均较对照组更差,差异有统计学意义（P〈0.01）。结论MCI患者不仅在记忆上较正常人差,可能在视空间与执行功能、注意、抽象思维方面存在损害。MoCA量表对MCI患者各认知方面可起到初筛作用。     

轻度认知功能障碍患者的神经心理学研究

目的 探讨轻度认知功能障碍(MCI)患者神经心理学的特点. 方法 对42例MCI患者和55例健康对照者进行多项神经心理学检查,包括简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、临床痴呆评定量表(CDR)、语言流畅性测验(RVR)、韦氏智力测验(WAIS-RC)[包括数字广度测验(DS)、积木测验(BD)、相似性测验]、韦氏记忆测验(WMS-R)(包括逻辑记忆、联想学习、视觉再认、图片回忆)、日常生活能力量表(ADL),比较2组患者上述量表评分和MMSE、MoCA量表各亚项评分的差异.结果 与对照者比较,MCI患者MMSE、MoCA总分和RVR、WAIS-RC、WMS-R分测验,MoCA量表各亚项(地点定向力除外),MMSE量表中计算与注意、延迟回忆两亚项评分较低,差异均有统计学意义(P<0.05).结论 MCI患者不仅记忆受损,其计算与注意力、命名、视空间结构能力、执行功能也可受损,尤以延迟回忆、计算与注意力受损明显.MoCA涵盖了重要的认知领域,能较全面评估MCI患者的认知功能,值的临床推广应用.     

认知障碍简明评价表对帕金森病患者轻度认知功能障碍的诊断价值

目的探讨认知障碍简明评价表(Cog-12量表)对帕金森病(PD)患者轻度认知功能障碍的诊断价值。方法将85例PD患者按认知障碍诊断标准分为认知功能正常组(45例)、轻度认知功能障碍组(PD-MCI)组(40例)。采用Cog-12量表、蒙特利尔认知评估量表(MoCA)及MMSE量表对患者进行测评,分析3个量表对PD患者轻度认知障碍的筛查能力。结果与认知功能正常组比较,PD-MCI组Cog-12量表评分显著升高,MoCA、MMSE量表评分显著降低(均P0.001)。Cog-12对PD患者MCI的鉴别能力明显优于MoCA、MMSE(AUC_(Cog-12)=0.958,敏感度为85.7%,特异度为75%;AUC_(MMSE)=0.798,敏感度为52.4%,特异度为26.5%;AUC_(MoCA)=0.907,敏感度为71.4%,特异度为21.5%)。当Cog-12界值为7.5分时,其敏感性为85.7%。结论 Cog-12量表可有效检测PD患者的认知功能损伤,可应用于临床PD患者认知功能的筛查。     

血清胆红素和尿酸浓度与轻度认知障碍的相关性研究

目的探讨轻度认知功能障碍(MCI)患者血清胆红素和尿酸水平与认知功能的关系。方法检测71例MCI患者(MCI组)及80名认知正常者(对照组)患者的血尿酸、总胆红素(TB)、直接胆红素(DBIL)、间接胆红素(IBIL)水平。采用MMSE和蒙特利尔认知评估量表(MoCA)对入组者行神经心理学评定。结果与对照组比较,MCI组年龄及吸烟史比率显著升高(均P0.05),受教育年限、MMSE评分、MoCA评分、MoCA子评分中的视空间与执行能力、注意力、抽象思维、延迟回忆及TB、IBIL、尿酸浓度显著降低(P0.05～0.01)。TB与MMSE、MoCA评分呈正相关(r=0.287,P=0.030;r=0.347,P=0.024),与MoCA子项目中的视空间与执行功能、抽象思维、延迟回忆呈正相关(r=0.327,P=0.040;r=0.310,P=0.028;r=0.315,P=0.038)。尿酸与MMSE、MoCA评分呈正相关(r=0.293,P=0.030;r=0.337,P=0.013),与MoCA子项目中的视空间与执行功能、注意力、延迟回忆、抽象思维呈正相关(r=0.300,P=0.021;r=0.318,P=0.013;r=0.302,P=0.020;r=0.296,P=0.025)。多因素Logistic回归分析显示,高龄、低教育程度和吸烟是MCI的独立危险因素(P0.05～0.01),TB及尿酸水平是MCI的保护性因素(均P0.05)。结论高龄、低教育程度和吸烟可促进MCI发生,TB及尿酸水平可防止MCI。     

Validation studies of the Portuguese experimental version of the Montreal Cognitive Assessment (MoCA): confirmatory factor analysis

The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument created with the purpose of overcoming some of the insufficiencies of the Mini-Mental State Examination (MMSE). The MoCA evaluates more cognitive areas and is comprised of more complex tasks as compared with the MMSE, which makes it a more sensitive instrument in the detection of Mild Cognitive Impairment (MCI), a state that often progresses to dementia. In this study we performed an analysis of the psychometric and diagnostic properties of the Portuguese experimental version of the MoCA in a clinical sample of 212 subjects with MCI and several dementia subtypes in a memory clinic setting. Additionally, we performed a Confirmatory Factor Analysis (CFA) to assess the MoCA’s latent factorial structure. In a clinical population, the MoCA is a valid and reliable instrument with good psychometric properties, revealing high sensitivity in identifying MCI and dementia patients who generally score within the normal range on the MMSE. By using the parcels method, CFA results showed very good/excellent adjustment indexes. The practical implications of this CFA study allow us to propose a two factor model factorial structure for the MoCA: a first factor designated MEMORY, which includes memory, language and orientation subtests (the latter being closely correlated with the former), and a second factor designated ATTENTION/EXECUTIVE FUNCTIONS, comprised of attention, executive functions and visuospacial abilities tasks.     

蒙特利尔认知评估量表在帕金森病认知障碍患者中的应用价值

目的 分析蒙特利尔认知评估(MoCA)量表(中文版)在筛查帕金森病(PD)患者中认知障碍的应用价值.方法 使用RoSA编制的,根据年龄及教育程度调整的MMSE分界值筛出整体认知功能正常的213例PD患者,并进一步使用MoCA量表对其进行分组,MoCA评分≥26分的PD患者入PD认知正常组(PD-NC组),MoCA评分<26分的PD患者入PD认知损害组(PD-CI组).比较2组患者MoCA各分测验分数的差异及认知功能改变的特点,并应用单因素及多元Logistic回归分析PD患者认知损害的影响因素.结果 (1)PD组患者中52.6%(112/213)的患者MoCA评分<26分;(2)与PD-NC组比较,PD-CI组在MoCA视空间和执行、命名、注意力、语言、抽象、延迟回忆、定向分测验中得分诸项比较均有统计学意义;(3)Logistic回归分析结果显示,低文化程度是PD患者认知损害的影响因素(OR:0.72,95%CI0.64～0.81,P<0.05).结论 MMSE正常者中仍然存在相当比例的患者MoCA评分异常.因此,临床上建议使用MoCA对PD患者认知水平进行测试,在患者未达到PD痴呆时,应结合患者的教育水平及时发现并处理患者认知损害症状,使PD患者得到及时治疗并能提高生活质量.

Abstract：

Objective To examine the application of Montreal Cognitive Assessment (MoCA) in Parkinson' s disease (PD) patients with normal general cognitive function by Mini-Mental State Examination (MMSE) evaluation.Methods PD patients were examined with MMSE, and those having a normal ageand education-adjusted MMSE score were included in the further study of MoCA testing.The patients with MoCA score not less than 26 were selected into normal control PD-NC group, and the patients with less than 26 into cognitive impaired PD-CI group.Scores of MoCA subtests were used in PD-CI group and PD-NC group to characterize cognitive changes in PD patients with mild cognitive impairment (MCI).MoCA score in PD-CI group used as dependent variable, and sex, educational level, age, course of disease, Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Self-rating depression Scale (SDS), Self-rating Anxiety Scale (SAS) and Unified Parkinson' s Disease Rating Scale (UPDRS) were used as independent variable, the risk factors of CI in PD patients was analysed by Linear Regression Analysis.Results There are 52.6% (112/213) PD patients with MMSE ≥ 26 while their MoCA < 26.Significant differences were observed in subtests of MoCA in visuospatial, executive, naming, attention,language, abstract, delayed recall and orientation between PD-CI group and PD-NC group (all P <0.01).Univariate and multivariate regression analysis showed that educational level is the most significant factor in PD-CI (OR:0.72, 95% CI 0.64-0.81, P < 0.05).Conclusions There is a high proportion of PD patients whose MMSE test showed normal but MoCA test showed cognitive impairment.MoCA examination was used to detect cognitive function of PD patients.Furthermore we suggest consider the education level in PD patients when evaluate their cognitive function.     

Brief screening for mild cognitive impairment in elderly outpatient clinic: validation of the Korean version of the Montreal Cognitive Assessment

The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening tool with high sensitivity for screening patients with mild cognitive impairment (MCI). The authors examined the validity and reliability of the Korean version of the MoCA (MoCA-K) in elderly outpatients. The MoCA-K, a Korean version of the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR) scale, and neuropsychological batteries were administered to 196 elderly persons (mild Alzheimer's disease [AD] = 44, MCI = 37, normal controls [NC] = 115). MoCA-K scores were highly correlated with those of MMSE and CDR. Using a cutoff score of 22/23, the MoCA-K had an excellent sensitivity of 89% and a good specificity of 84% for screening MCI. Internal consistency and test-retest reliability were good. The results obtained show that the MoCA-K is brief, reliable, and suitable for use as a screening tool to screen MCI patients in elderly outpatient clinic settings.     

Clinical application of the Polish adaptation of the Montreal Cognitive Assessment (MoCA) test in screening for cognitive impairment

Background and purposeThe Montreal Cognitive Assessment (MoCA) test is a brief cognitive screening tool with high sensitivity and specificity for detecting mild cognitive impairment (MCI). The aim of this study was to evaluate the usefulness of MoCA and compare it with the Mini-Mental State Examination (MMSE) in the early detection of cognitive decline in MCI.Material and methodsA group of 115 subjects (36 meeting DSM-IV criteria for Alzheimer disease (AD) [Clinical Dementia Rating (CDR) = 1], 42 meeting Petersen's criteria for MCI [CDR = 0.5], and 37 cognitively intact controls [CDR = 0]) was recruited for the study in the university-based Alzheimer out-patient clinic. All participants underwent general medical, neurological, and psychiatric examinations. The MoCA, the MMSE, CDR and the short (15-item) version of the Geriatric Depression Scale were also applied.ResultsBoth MCI and AD groups exhibited impaired performance on MoCA compared to controls. Polish versions of the MMSE and MoCA tests were comparable in discriminating mild dementia from both MCI and control groups. The Polish version of the MoCA test performed marginally better than MMSE in discriminating MCI from controls. We propose to use the MoCA test to screen for MCI using an optimal cut-off score of 24 and to screen for dementia using a cut-off score of 19.ConclusionsThe Polish version of the MoCA seems effective in the detection of deteriorated cognitive performance and appropriate for differentiating impaired from preserved cognitive function in a Polish population.     

MoCA与MMSE对首发脑梗死患者认知功能的评估应用

目的探讨蒙特利尔认知评估量表（MoCA）与简易智能状态检查量表（MMSE）在脑梗死患者认知功能评估中的应用。方法选择首发单一病灶脑梗死患者160例,在其发病3个月后,用MoCA与MMSE进行认知功能检测,并将不同性别、年龄段、受教育程度患者的MoCA与MMSE评分进行比较。结果不同性别、年龄、受教育程度患者的MoCA评分均低于MMSE评分,差异有统计学意义（P〈0.01）。年龄（β=-3.176,P=0.000）、性别（β=2.189,P=0.002）、受教育程度（β=2.032,P=0.000）为MoCA评分的影响因素。结论与MMSE相比,MoCA更适用于脑梗死后认知功能障碍诊断,其评分受患者年龄、性别、受教育程度影响。     

蒙特利尔认知评估量表识别首次卒中后轻度血管性认知障碍的作用

目的 探讨蒙特利尔认知评估量表(MoCA)识别首次卒中后轻度血管性认知障碍(mVCI-FS)的作用,并与简易智能精神状态量表(MMSE)比较. 方法 选取mVCI-FS患者60例.首次卒中后非血管性认知障碍(nVCI-FS)25例,于发病后(12+1)周由不知情的神经科医师进行MoCA及MMSE评估. 结果 MoCA总平均分为(19.78±4.573)分,MMSE为(25.48±3.148)分,偏相关分析间.r=9,P=0.000.MoCA除计算力和言语流畅性外,其余各项在mVCI-FS和nVCI-FS间差异均有统计学意义(P<0.05);MMSE的即刻记忆、计算力、命名和阅读理解在2组间差异无统计学意义(P>0.05).应用ROC曲线和Youden指数最大值初步确定MoCA识别mVCI-FS与nVCI-FS的最佳分界值为21分.以21分为分界值.MoCA筛查mVCI-FS的敏感度和特异度分别为84.6%和76.0%,明显优于MMSE(敏感度59.6%和特异度57.7%),差异有统计学意义(P<0.05). 结论 初步确定MoCA识别mVCI-FS与nVCI-FS的最佳分界值为21分.MoCA筛查mVCI-FS的敏感度和特异度均高,是一种有效的mVCI.FS筛查量表;MMSE对mVCI.FS的敏感度低,识别mVCI-FS的作用有限.     

运动想象疗法对脑卒中患者认知功能的康复作用

目的探讨运动想象疗法对脑卒中患者认知功能的康复作用。方法共99例伴轻中度认知功能障碍的脑卒中患者随机接受常规康复训练(对照组,33例)以及在此基础上联合认知功能训练(33例)和运动想象疗法(33例),于训练前和训练8周时采用简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(Mo CA)评价认知功能,事件相关电位检测P300潜伏期和波幅。结果与训练前相比,训练8周时3组患者MMSE(P=0.000)和Mo CA(P=0.000)评分增加、P300潜伏期缩短(P=0.000)和波幅升高(P=0.000);3组患者训练前后MMSE(P=0.030)和Mo CA(P=0.013)评分、P300潜伏期(P=0.004)和波幅(P=0.009)差异有统计学意义,其中,认知功能训练组和运动想象疗法组MMSE(P=0.019,0.021)和Mo CA(P=0.003,0.031)评分高于、P300潜伏期短于(P=0.020,0.003)和波幅高于(P=0.003,0.002)对照组。结论基于运动想象疗法的康复训练在提高脑卒中患者运动功能的同时亦改善认知功能。     

晚发型抑郁障碍与轻度认知功能损害患者的认知功能差异研究

目的 探讨晚发型抑郁障碍患者与轻度认知功能损害患者的认知功能损害的差异.方法 研究对象为2012年7月～2013年8月上海市精神卫生中心老年科住院与门诊就诊符合DSM—Ⅳ诊断标准且起病年龄≥60岁的抑郁障碍患者,共26例为晚发型抑郁障碍组（LOD组）,另选择26例轻度认知功能损害的患者（MCI组）与26例正常老年人（NC组）.认知功能评估采用简明精神状态量表（MMSE）、蒙特利尔量表（MoCA）.结果 MMSE总分、MMSE分测验中计算力与注意力及MoCA总分、MoCA分测验中连线、注意、持续注意、计算、复述、延迟回忆在LOD组与MCI组差比较异无统计学意义（P＞0.05）,两组与NC组比较差异有统计学意义（P＜0.05）.三组在MMSE分测验的时间定向、延迟回忆、三步指令、书写书面指令及MoCA分测验的复制图、画钟、命名比较,MCI组均值最低,与NC组比较差异有统计学意义（P＜0.05）,与LOD组比较差异无统计学意义（P＞0.05）.结论 LOD组认知功能在注意力、延迟回忆、连线测验方面与MCI组损害程度相当.MCI组认知功能受损范围较LOD组广泛.     

Changes on brief cognitive instruments over time in Parkinson's disease

Two hundred and twenty-one subjects with Parkinson's disease (PD) were examined using the Mini-Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA), with a subset of these (n = 98) examined on repeat testing up to 3 years. The MoCA was more sensitive in identifying cognitive deficit, specifically in the domains of visuospatial abilities, language, and memory. In longitudinal study, the MMSE changed significantly over time, particularly in patients with disease duration of >10 years. The MoCA, however, did not change significantly, even when subjects were stratified by age, MMSE score, and disease duration. This suggests that the MoCA may be more sensitive for detecting early cognitive change in PD, but that the MMSE, and not the MoCA, may be better for tracking cognitive decline. ? 2012 Movement Disorder Society.