Thai Mental State Examination Performance in Patients with Parkinson’s Disease according to Montreal Cognitive Assessment Score in Detecting Mild Cognitive Impairment
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Abstract
Objectives: Mild cognitive impairment (MCI) is common among individuals with Parkinson’s disease (PD), affecting approximately 20%-70%, and often progress to PD dementia. Routine cognitive evaluation is essential for early detection and management of PD with MCI. Although various cognitive screening tools are available, including the Montreal Cognitive Assessment (MoCA) and Thai Mental State Examination (TMSE), the validity of the TMSE in detecting MCI among PD patients has not been established.
Materials and Methods: A cross-sectional study of 100 patients with PD at Vajira Hospital was conducted. Cognitive function was assessed using the Thai versions of the MoCA (Thai-MoCA) and TMSE. Patients with dementia or advanced PD were excluded. The diagnostic performance of TMSE in identifying MCI was evaluated using the Thai-MoCA as the reference screening test, with sensitivity, specificity, and predictive values calculated. Optimal cutoff scores were determined using Youden’s index.
Results: Of the 81 patients identified with MCI by Thai-MoCA, only 19 (23.5%) were classified as having MCI by TMSE, while 62 (76.5%) were not. The TMSE showed a sensitivity of 23.5% (95% confidence interval (CI): 14.8–34.2) and specificity of 100% (95% CI: 82.4–100). The positive predictive value was 100% (95% CI: 82.4–100), negative predictive value was 23.5% (95% CI: 14.8–34.2), and overall accuracy was 38.0% (95% CI: 28.5–48.3). The optimal TMSE cutoff score of < 28 improved sensitivity to 77.8% (95% CI: 67.2–86.3) while maintaining specificity at 100% (95% CI: 82.4–100).
Conclusion: The TMSE exhibited low sensitivity for identifying MoCA-defined MCI among patients with PD when using standard criteria. However, adjusting the cutoff score to < 28 substantially increased sensitivity while maintaining high
specificity. This modified cutoff may improve the sensitivity of TMSE for identifying MoCA-defined MCI in PD patients, although further validation in independent populations is required.
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