RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME AND ADDRESS OF THE
Department of Physiotherapy
M.S.Ramaiah Medical College
M.S.R.I.T Post, Bangalore-54
2. NAME OF THE INSTITUTION
: Department of Physiotherapy
M.S.Ramaiah Medical College
M.S.R.I.T Post, Bangalore-54
3. COURSE OF STUDY AND
: Master of Physiotherapy
(Neurological and Psychosomatic Disorders)
4. DATE OF ADMISSION TO COURSE
5. TITLE OF THE STUDY
: 02nd July, 2012
: “Comparison of Montreal Cognitive
Assessment and 7 Minute Screen
to assess Mild Cognitive
6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
Aging process leads to a change in cognitive ability, although the magnitude of
change can vary markedly. Aging can have diverse effects on cognitive function. For
many people, aging is associated with little cognitive decline (healthy or successful
aging).For some, memory declines significantly with age, but does not prevent
performance of daily activities.1
From early adulthood there is a decline in mental domains such as processing,
Reasoning, speed, memory and executive functions.2Age associated memory
impairment is a common condition characterized by very mild symptoms of cognitive
decline that occurs as a part of the normal ageing process. 3Cognitive impairment is
a major health and social issue that can have an impact on the patient’s ADLs.4
However, classification of different degrees of cognitive decline ( but not dementia)
has not been clearly established.5 The presence of mild cognitive Impairment (MCI)
is common in elderly patients and can have an impact on prognosis and quality of
life.The concept of MCI was noted by Dr Ronald Peterson, refers to cognitive deficits
that exceed age-related cognitive decline but do not fulfill criteria for dementia: MCI
can be classified into two categories.
1. Amnestic MCI where memory impairment is predominant
2. Non amnestic MCI where there is impairment in other domains such as language,
attention, visuospatial function.6
MCI is distinguished from mild dementia by absence of global intellectual
deteriorationand significant deficits in ADLs. Recent studies have shown that patient
with MCI canlive independently and are generally preserved in their ADLs, but
complex instrumentalADLs could be minimally impaired.4
Cognitive screening in elderly is important for the purpose of identifying the presence
ofcognitive impairment. Although several screening tools are available for
detectingdementia, the Folstein Mini Mental Scale Examination is the most popular
cognitive testbeing used but, it has low sensitivity for MCI. 7Among the few validated
studies forscreening MCI, the Montreal Cognitive Assessment
has shown to
haveexcellent sensitivity and specificity toMCI.8MoCA is a simple screening tool that
coversimportant cognitive domains and can be administered in 10-12 minutes
therefore can beused in a clinical setting where time is often limited.5
Similarly the 7 Minute Screen Test (7 MS) has also shown to be superior to the
MiniMental State Examination with regard to mild cognitivedeficits9. It tests several
cognitivedomains and can be administered in 12 minutes. The Montreal Cognitive
Assessmentand the 7 minute screen test can distinguish patients with mild cognitive
impairmentfrom cognitively intact older person.10
An ideal Cognitive screening instrument that can be used in a primary care
settingshould be brief, accurate, simple to administer, acceptable to patients, less
timeconsuming and should have a broad coverage of cognitive domains. Therefore
there isa need to identify a better primary care screening tool for MCI.
As MoCA and 7 Minute Screen Test are nearly similar in these aspects a
comparative study between these two scales would help in identifying which scale
can be used in a clinical setting.
ALTERNATE HYPOTHESIS:MoCA is less time consuming and a more effective
screening tool than 7 minute screen test to assess MCI in an elderly population.
NULL HYPOTHESIS: 7 minute screen test is less time consuming and a more
effective screening tool than MoCA to assess MCI in an elderly population.
6.2 REVIEW OF LITERATURE:
T Hanninen (2002) et al conducted a study to estimate the prevalence of mild
cognitive impairment in a population based study in elderly subjects. A total of 806
subjects were evaluated, results showed that MCI was more prevalent in older and
less-educated subjects,but no difference was found between men and women. 5
ArunAggarwal , Emma Kean(2010) conducted a study to compare the Folstein Mini
Mental State to the Montreal Cognitive Assessment as a Cognitive Screening Tool in
an Inpatient Rehabilitation Setting. A total of 50 subjects were studied with an
average age of 71.7 years of age. The mean test score for MMSE was 26.5 and for
MoCAwas 22.2.MMSE did not perform well as a screening instrument for MCI and
therefore concluded thatMoCA can be used over the widely used MMSE for
screening Mild cognitive impairment.8
Jin-SookCheon(2005) et al compared cognitive function in Dementia and Major
depressive disorder using the 7 minute screen test. The 7 minute screen and
MMSEwere performed with 26 patients exhibiting Alzheimer’s type dementia,
vascular dementia, major depressive disorder.Results showed that the 7 Minute
Screen was superior to MMSE at detecting mild cognitive deficits and also proved
useful in the discrimination of differences between dementia and depression. 9
Ulrike Beinhoff (2005) et al conducted a study to develop a triage for bedside testing
and outpatient services. In a prospective clinical cohort study at the outpatient
memory clinic, 232 subjects were diagnosed with Alzheimer’s disease. Six brief
screening tests including the MIS, LST, VF,and CDT were assessed independently
from diagnostic procedure. Results showed that LST yielded a diagnostic accuracy
for AD and MCI patients. With a combination of LST, MIS,VF, and CDT, sensitivity
for AD and MCI was more and therefore concluded that screening tests will help
detect patients with AD and MCI.10
Michael Lerch(2010) et al conducted a study comparing MMSE with MoCA and
Clock drawing test.100 geriatric patients were tested with all three tests in random
order on three consecutive days. Results concluded that MMSE detected only 54%
of dementia patient, the MoCA found 89% of these, therefore recommending
thatMoCAcould be used as a primary screening tool in geriatric patients. 11
A.P.Krishna(2011) et al conducted a study to evaluate the efficacy of 7 minute
screen test for assessment of elderly who are at a risk of developing dementia and
concluded that this test could detect dementia at an early stage.12
6.3 OBJECTIVES OF THE STUDY:
1. To compare the Montreal Cognitive Assessment and 7 Minute Screen Test for
assessment of Mild Cognitive Impairment in an elderly population.
7. MATERIALS AND METHODOLOGY:
7.1 SOURCE OF COLLECTION OF DATA: Geriatric population between 60-76
years of age, from Out Patient Department of M.S.Ramaiah medical college in
7.2 METHOD OF COLLECTION OF DATA:
Method of sampling:Convenience sampling
Type of study:Observation, prospective type of study
Sample Size:95(From the study conducted by EF J Meulen et al (2004)
7 minute screen a neurocognitive screening test the
sensitivity was Found to be 92.9%. Keeping power
of study at 80%and alpha error of 5% sample size
PROCEDURE OF DATA COLLECTION:
Geriatric patients between the age group 60-76 years will be recruited from the Out
Patient Department of M.S. RamaiahHospital. Patients who meet the inclusion
criteria will be included in the study. The study shall be explained in detail following
which an informed consent will be obtained. Instructions and the components of the
two scales shall be explained prior to their administration. Next, the cognitive
functions shall be assessed on two consecutive days. On day 1 Montreal Cognitive
Scale will be administered, time taken to complete the scale will be recorded,
following day screening will be done using 7 Minute Screen Test and time taken to
complete this scale will be noted. At the end of the session the scores for individual
scales will be calculated. Each session will last for around 10-15 minutes.
Males and females 60-76 years of age.
Patients who are not demented.
Normal general cognitive function.
Subjects should be well educated to understand English.
Subjects with normal hearing abilities.
Patients with neurological disorders.
Moderate to Severe cognitive impairments or presence of any psychiatric
Subjects who are visually and hearing impaired.
Montreal Cognitive Assessment (Original Version 7.1)
The 7 Minute Screen Test.
All the Quantitative variables like age, memory, orientation, language, attention,
executive functionwill be expressed in terms of Mean and Standard deviation. All
qualitative variables will be expressed in terms of proportions. The sensitivity &
specificity of 7 minute screen test and MoCA will be determined. Logistic regression
analysis will be carried out to find out the independent factors affecting cognitive
7.3Does the study require any investigation or intervention to be conducted on
patients or other human or animals?
7.4Has the ethical clearance been obtained from the institution in case of 7.3?
8. LIST OF REFERENCES:
1. Elizabeth AK, Suzzane C. Cognition in ageing and age-related disease.
ElseiverPress :New York;2003.
2. Ian JD, Jannie C, Alan JG, Sarah EH, Lorna MH, Riceardo EM et al. Age
Associated cognitive Decline. Journal of British Medical Bulletin.2009;92:135152.
3. Tuomo H, Keijo K, Kari JR, Eeva LH, Hilkka S, Leena M , Keijo. Prevalence of
Ageing-associated Cognitive Decline in an Elderly Population. Journal of Age
4. Inn SA, Ji-Haekim, Seonwoo K, Jae Wonchung, Hyeran K, HyoShinkang et
al. Impairment of IADL in patients with MCI. Journal of Psychiatry Invest.
5. Hanninen T, Hallikainen M, Tuomainen S, Vanhanen M, Soininer H et al.
Prevalence of mild cognitive impairment – a population based study in elderly
subjects. Acta Neurology Scandal.2002;106(3):148-154.
6. Peterson R C. Mild Cognitive Impairment in Elderly. New England Journal of
7. ZaidNasreddin. Short Clinical Assessments Applicable to Busy Practices.
Journal of Primary Psychiatry.2008;15(10):6-9.
8. ArunAggarwal, Emma Kean. Comparison of the Folstein Mini Mental State
Examination to the Montreal Cognitive Assessment as a Cognitive Screening
9. Jin-Shook C, Han-Cheol Y, Byoung H. Comparison of cognitive function in
dementia and major depressive disorders using the 7 Minute Screen Test.
Journal of Psychiatry Invest.2005;2(1):66-71.
10. Ullrike B, Verena H, Daniel B, Georg G, Matthiasw.R. Screening for Cognitive
Impairment: A Triage for Outpatient Care. Dement GeriatrCogn Disord.2005;
11. Michael L, Mechthild D, Stefan F, Yvonne H. Could the MoCA be the” new
gold standard” in cognitive evaluation in geriatric patient. Journal of
12. Krishna AP Sen PA, Shrikant LP. Evaluation of the efficacy of the 7 Minute
Screen Test for assessment of risk for dementia. Asian Journal Exp.Biol.
13. Meulen EFJ, Schmand B, Vancampen JP, Ponds RW, Scheltens P et al. The
Seven Minute Screen, a neurocognitive screening test highly sensitive to
9. SIGNATURE OFTHE CANDIDATE:
10.REMARS OF THE GUIDE:
11. NAME AND DESIGNATION Of
: Mr. Nanda Kumar
Department Of Physiotherapy
M.S.Ramaiah Medical College
11.3 NAME AND DESIGNATION OF
: Miss.Aditi Hombali
Department Of Physiotherapy
M.S Ramaiah Medical College
11.5 HEAD OF DEPARTMENT:
Head Of Department
M.S. Ramaiah Medical College
12. REMARKS OF THE CHAIRMAN AND
I,Mr./Ms......................................................, of age...........years, have been informed about
the foregoing study “Comparison of Montreal Cognitive Assessment and 7 Minute
Screen Test to assess Mild Cognitive Impairment in a Geriatric population” by
I have had the opportunity to ask questions in the study and all my questions about the
study and my part in it have been answered to my satisfaction.
I am aware of the procedure of the study.
I am aware of the complication and risk factors.
I am aware of the potential benefits of the study.
I am aware that my health information will be used and shared
I freely consent to be in this research study.
In case of any mishap I will not blame the researcher or the institution.
STATEMENT OF WITNESS
I have witnessed the accurate reading of the consent form by the potential participant, and
the individual has had the opportunity to ask questions. I confirm that the individual has
given consent freely.
NOTE: THE DETAILS OF THE ASSESSMENT SCALES(MONTREAL COGNITIVE
ASSESSMENT VERSION 7.1 AND 7 MINUTES SCREEN TEST) ARE ATTACHED
TO THE HARD COPY OF THE SYNOPSIS