Marta Statucka1, Kirsten Cherian2,3, Alfonso Fasano1,4,5, Renato P Munhoz1,4,5, Melanie Cohn1,6. 1. Krembil Brain Institute Toronto Western Hospital UHN Toronto Ontario Canada. 2. Baycrest, Neuropsychology & Cognitive Health Toronto Ontario Canada. 3. Palo Alto University Palo Alto California USA. 4. Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN Toronto Ontario Canada. 5. Division of Neurology University of Toronto Toronto Ontario Canada. 6. Psychology Department University of Toronto Ontario Canada.
Abstract
BACKGROUND: The Montreal Cognitive Assessment (MoCA) and the Dementia Rating Scale-2 (DRS-2) are recommended screeners for Parkinson's disease mild cognitive impairment (PD-MCI). Cross-cultural studies examining their diagnostic precision have not addressed cultural bias in a multicultural setting. OBJECTIVES: To compare DRS-2 and MoCA performance between patients born in Canada, the USA, and the UK (Anglosphere group) and immigrant patients born elsewhere (International group). To identify sources of cultural bias by comparing group characteristics, and by assessing the relationships between performance and immigration and socio-development variables. To examine the diagnostic precision of both tools in detecting PD-MCI in each group. METHODS: We conducted a clinical chart review of advanced PD patients who completed cognitive screeners (MoCA: n = 288, 30% International group; DRS-2: n = 426, 31% International group). All completed a comprehensive neuropsychological assessment to apply Level II PD-MCI diagnostic criteria. RESULTS: The International group performed worse than the Anglosphere group on the MoCA and DRS-2, and the only variable that accounted for some of the group difference was the Historical Index of Human Development, a societal variable, which fully mediated the group effect on the DRS-2. Diagnostic precision of the MoCA was at chance level in the International group, and was poorer than that of the DRS-II in this group and that of the MoCA in the Anglosphere group, although these were considered poor. CONCLUSIONS: Our results support the recommendation to exert caution in using cognitive screeners to capture PD-MCI in all patients and particularly with first generation immigrants.
BACKGROUND: The Montreal Cognitive Assessment (MoCA) and the Dementia Rating Scale-2 (DRS-2) are recommended screeners for Parkinson's disease mild cognitive impairment (PD-MCI). Cross-cultural studies examining their diagnostic precision have not addressed cultural bias in a multicultural setting. OBJECTIVES: To compare DRS-2 and MoCA performance between patients born in Canada, the USA, and the UK (Anglosphere group) and immigrant patients born elsewhere (International group). To identify sources of cultural bias by comparing group characteristics, and by assessing the relationships between performance and immigration and socio-development variables. To examine the diagnostic precision of both tools in detecting PD-MCI in each group. METHODS: We conducted a clinical chart review of advanced PD patients who completed cognitive screeners (MoCA: n = 288, 30% International group; DRS-2: n = 426, 31% International group). All completed a comprehensive neuropsychological assessment to apply Level II PD-MCI diagnostic criteria. RESULTS: The International group performed worse than the Anglosphere group on the MoCA and DRS-2, and the only variable that accounted for some of the group difference was the Historical Index of Human Development, a societal variable, which fully mediated the group effect on the DRS-2. Diagnostic precision of the MoCA was at chance level in the International group, and was poorer than that of the DRS-II in this group and that of the MoCA in the Anglosphere group, although these were considered poor. CONCLUSIONS: Our results support the recommendation to exert caution in using cognitive screeners to capture PD-MCI in all patients and particularly with first generation immigrants.
Authors: Connie Marras; Melissa J Armstrong; Christopher A Meaney; Susan Fox; Brandon Rothberg; William Reginold; David F Tang-Wai; David Gill; Paul J Eslinger; Cindy Zadikoff; Nancy Kennedy; Fred J Marshall; Mark Mapstone; Kelvin L Chou; Carol Persad; Irene Litvan; Benjamin T Mast; Adam T Gerstenecker; Sandra Weintraub; Sarah Duff-Canning Journal: Mov Disord Date: 2013-03-20 Impact factor: 10.338
Authors: Murat Emre; Dag Aarsland; Richard Brown; David J Burn; Charles Duyckaerts; Yoshikino Mizuno; Gerald Anthony Broe; Jeffrey Cummings; Dennis W Dickson; Serge Gauthier; Jennifer Goldman; Christopher Goetz; Amos Korczyn; Andrew Lees; Richard Levy; Irene Litvan; Ian McKeith; Warren Olanow; Werner Poewe; Niall Quinn; Christina Sampaio; Eduardo Tolosa; Bruno Dubois Journal: Mov Disord Date: 2007-09-15 Impact factor: 10.338