A comparison of the demographic variables for the patients that met the inclusion criteria with those that did not, revealed no significant differences except in terms of stroke severity, laterality, and comprehension impairment. The results of the cognitive evaluations (MMSE vs. MoCA, r = .79, p < .001; MMSE vs. cFIM, r = .56, p < .000; MoCA vs. cFIM, r = .67, p < .000) revealed good agreement between the three instruments (Toglia et al., 2011) and mirrored the results of Stewart et al. (2012). A comparison of the mean scores for MMSE and MoCA, however, revealed a significant difference (24.4 vs. 17.8, respectively, p < .001) in terms of sensitivity to subtle changes in cognition. This finding supports the conclusion that the MoCA may be more sensitive to MCI than the MMSE. The Chronbach ? For the MMSE was only .60, which is .10 below an acceptable level of internal consistency, while Chronbach ? For MoCA was .78. In addition, 67% of the patients scoring 27 or higher on the MMSE obtained a score below 26 on the MoCA. Additional comparisons were performed and together the authors concluded that MoCA was a better predictor of MCI, has better internal reliability, and was equal to the MMSE in prediction physical rehabilitation outcomes.

The study conducted by Toglia and colleagues (2011) provided convincing evidence of the reliability and validity of the MoCA instrument. The only limitation was small sample size, but again, the results were so dramatic that this can be overlooked. This also is a quasi-experimental study (Schmidt & Brown, 2012 investigating diagnostic accuracy using a cross-sectional design (Aslam, Georgiev, Mehta, & Kumar, 2012).

Conclusions

There is increasing interest in MCI screening because credible findings may alter best practice recommendations for slowing progression to dementia or the rehabilitation strategies used for stroke victims. Although MoCA is not currently included in clinical guidelines for cognitive impairment, this may change in the near future based on a growing body of evidence that suggests MoCA is superior to the gold standard MMSE when screening for MCI. Based...

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