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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objective: This study was performed to provide a detailed analysis of the MoCA versus the MMSE, including an item analysis and an examination of threshold scores appropriate for use in different clinical settings. Methods: 135 subjects enrolled in a longitudinal clinicopathologic study were administered the MoCA and MMSE. Subjects were classified as cognitively impaired or cognitively normal based on neuropsychological testing and consensus conference diagnosis. Results: 89 subjects were cognitively normal, 46 cognitively impaired (20 dementia, 26 MCI). ROC analysis showed that, for any threshold value selected for the MMSE to identify cognitive impairment, a MoCA value with better sensitivity and specificity could be identified. Recall performed best among individual items on the MMSE, and Orientation performed best on the MoCA. Overall, the best discrimination was obtained using a weighted combination of four items (2*MoCA-Orientation + MMSE-Recall + MoCA-Language + 0.5* MoCA-Visuospatial/Executive; AUC 0.94). A MoCA threshold score of 26 had a sensitivity of 98% and specificity of 52% for identifying cognitive 5 impairment. A MoCA threshold score of 21 had a sensitivity of 57% and specificity of 96%. Conclusions: The MoCA was superior to the MMSE in detecting cognitive impairment. Individual domains on the MoCA and MMSE made substantially different contributions to each instrument’s sensitivity, and a weighted subset of items from both instruments performed best in detecting cognitive impairment. A lower MoCA threshold score may be appropriate in a population with a higher prevalence of cognitive impairment such as a memory clinic.

Thesis (Ph. D.)--University of Chicago, Dept. of Philosophy, 2002. / Includes bibliographical references (p. 122-123). Also available on the Internet.

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This study was undertaken to introduce an innovative approach to cognitive rehabilitation intervention (Goal Management Training- GMT) delivery, through a web-based platform administered to adults with cerebrovascular disease (CVD) or suffering from CVD risk factors who presented with executive function impairments. The feasibility of this approach was investigated by developing a semi-quantitative-qualitative tool to measure therapist competence and group engagement adapted from the Cognitive Therapy adherence-to-protocol scale. Results from two raters analyzing random web-based GMT session recordings showed no compromise in any aspect measured. In addition, the efficacy of the intervention was established using neuropsychological and functional outcome measures, with significant results observed on the Goal Attainment Scale functional measure. To our knowledge, this study is the first of its kind to a) employ videoconferencing technology to overcome accessibility barrier to cognitive rehabilitation and b) develop an adherence to protocol tool to measure various aspects of GMT.

This study was undertaken to introduce an innovative approach to cognitive rehabilitation intervention (Goal Management Training- GMT) delivery, through a web-based platform administered to adults with cerebrovascular disease (CVD) or suffering from CVD risk factors who presented with executive function impairments. The feasibility of this approach was investigated by developing a semi-quantitative-qualitative tool to measure therapist competence and group engagement adapted from the Cognitive Therapy adherence-to-protocol scale. Results from two raters analyzing random web-based GMT session recordings showed no compromise in any aspect measured. In addition, the efficacy of the intervention was established using neuropsychological and functional outcome measures, with significant results observed on the Goal Attainment Scale functional measure. To our knowledge, this study is the first of its kind to a) employ videoconferencing technology to overcome accessibility barrier to cognitive rehabilitation and b) develop an adherence to protocol tool to measure various aspects of GMT.

Thesis (Ph. D.)--University of Texas at Austin, 2003. / Vita. Includes bibliographical references (leaves 102-112). Also available in an electronic version.