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Additional diagnoses include frontotemporal dementias, Parkinson’s disease and atypical Parkinsonian syndromes, vascular cognitive impairment, Lewy body disease, mild cognitive impairment, and subjective cognitive impairment. Approximately 70% of patients seen in this neurology clinic are diagnosed with probable AD. Data were obtained from records of 138 consecutive patients who had magnetic resonance imaging (MRI) with automated volumetric analysis (NeuroQuant©) and cognitive screening as part of routine clinical care at an outpatient neurology clinic specializing in neurodegenerative disorders. This study was conducted in accordance with guidelines on human experimentation and approved by the Cleveland Clinic institutional review board. Given the wider range of possible scores and potential to isolate impairments in memory retrieval, it was hypothesized that the MIS would show stronger positive associations with hippocampal volume than simple DR scores. The primary aim of the present paper is to explore the extent to which the two MoCA memory scores (i.e., DR and MIS) relate to hippocampal volume- a well-established correlate of memory encoding dysfunction - in a sample of patients presenting with cognitive complaints. Given the integration of cued recall and recognition, the MIS may show stronger associations with hippocampal volume than the DR score, which would thus enhance the utility of the MoCA for differentiating AD from other types of dementias. found that this score was better at predicting cognitive decline in mild cognitive impairment than the total score. In an effort to more effectively distinguish impairments in memory encoding from retrieval, the Memory Index Score (MIS) has been developed, which incorporates performance on these additional cued recall and recognition trials. Īs currently constructed, the MoCA’s Delayed Recall score (DR) only awards points for spontaneous recall, resulting in a metric that is limited by a restricted range (0–5) and an inability to distinguish between deficits in encoding from deficits in retrieval, even though cued recall and recognition trials can be administered. Only one prior study has investigated the ability of MoCA to identify different memory profiles, finding good utility in its ability to distinguish AD from Huntington’sdisease. Despite widespread use, there has been relatively little research into the neuroanatomical correlates associated with memory performance on the MoCA. Previous work assessing the association between hippocampal volumes and individual memory processes using standard neuropsychological measures has found robust associations with estimates of both learning and recall, as well as, recognition of previously learned material. This memory profile, commonly described as “amnestic type” memory loss, distinguishes AD from other dementia syndromes such as Lewy body disease and vascular cognitive impairment, in which recognition memory typically exceeds free recall (i.e., memory performance improves with cues). On cognitive testing this manifests as poor recall of previously learned information with little or no benefit from retrieval cues. AD is commonly associated with atrophy of the hippocampus and related mesial temporal structures that are critical for encoding new information. Of particular relevance in distinguishing AD from other dementia syndromes is the memory profile.
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An advantage of the MoCA over other screening tests is that performance can be deconstructed into cognitive domains, providing a more granular view of an individual’s cognition that may be used to inform the initial diagnostic considerations of patients presenting with cognitive complaints. The Montreal Cognitive Assessment (MoCA) is a widely-used screening tool for cognitive impairment in Alzheimer’s disease (AD) and other forms of dementia.