Rapid Screening for Cognitive Impairment in Parkinson's Disease: A Pilot Study. 2015

YanHong Dong, and Way Inn Koay, and Leonard Leong Litt Yeo, and Christopher Li-Hsian Chen, and Jing Xu, and Raymond Chee Seong Seet, and Erle Chuen Hian Lim
Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, BLK MD3 Level 4 #04-01, 16 Medical Drive, Singapore 117600 ; Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, 1E, Level 10, NUHS Tower Block, Kent Ridge Road, Singapore 119228 ; CHeBA, NPI, Euroa Centre, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia ; Division of Neurology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.

Aim. This study sought to establish the discriminant validity of a rapid cognitive screen, that is, the National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute protocol, and compare its discriminant validity to the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE) in detecting cognitive impairment (CI) in PD patients. Methods. One hundred and one PD patients were recruited from a movement disorders clinic in Singapore and they received the NINDS-CSN 5-minute protocol, MoCA, and MMSE. No cognitive impairment (NCI) was defined as Clinical Dementia Rating (CDR) = 0 and CI was defined as CDR ≥ 0.5. Results. Area under the receiver operating characteristic curve of NINDS-CSN 5-minute protocol was statistically equivalent to MoCA and larger than MMSE (0.86 versus 0.90, P = 0.07; 0.86 versus 0.76, P = 0.03). The sensitivity of NINDS-CSN 5-minute protocol (<9) was statistically equivalent to MoCA (<22) (0.77 versus 0.85, P = 0.13) and superior to MMSE (<24) (0.77 versus 0.52, P < 0.01) in detecting CI, while the specificity of NINDS-CSN 5-minute protocol (<9) was statistically equivalent to MoCA (<22) and MMSE (<24) (0.78 versus 0.88, P = 0.34). Conclusion. The NINDS-CSN 5-minute protocol is time expeditious while remaining statistically equivalent to MoCA and superior to MMSE and therefore is suitable for rapid cognitive screening of CI in PD patients.

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