Applied tests
The MoCA (Montreal Cognitive Assessment), MoCA B (Montreal Cognitive
Assessment- Basic), the mini-cog and the IADL Lawton-Brody were
translated by the authors and applied by two trained pharmacists. Since
there is currently no official translation of these tests into Albanian
language, this is the first study developing and using them in clinical
practice for the aim of this study.
- MoCA (Montreal Cognitive Assessment) emerged in 2005 as a screening
tool to identify patients with MCI (Mild Cognitive Impairment). It
consists of a 1 page test with 30 points in total which can be
administered within 10 minutes. This test asseses short-term memory or
delayed memory (5 points), visual-spatial skills by clock drawing (3
points), copying the cube (2 points) and also orientation (6 points).
Executive functions are assessed by phonetic eloquence (1 point) and
oral abstraction (2 points), for attention, (2 points) for figures and
calculations (3 points). Language is appraised through animals
denominating (3 points), repeating of sentences (2 points) and
expressiveness. One point is added for patients having 12 or less than
12 years of education.
- MoCA B (Montreal Cognitive Assessment - Basic) was created as a
screening tool to identify patients with MCI with a low level of
education or illiterate patients. (7)
- Mini-Cog is a 3-minutes tool used to increase the detection of
cognitive impairment among adults. It can be used effectively after a
short training in healthcare facilities and in the community. It is made
up of two elements, a memory test of recalling three words and a simple
test of drawing the clock. The mini-cog may be used for the rapid
diagnosis of cognitive impairment during a routine visit or other
clinical service. A total score of 3, 4, or 5 shows lower probability of
dementia but does not preclude slight cognitive impairment.(8)
A recent study concluded that currently the limited number of published
studies and their methodological differences and limitations do not
support either recommendations for using nor avoiding the Mini-Cog as a
cognitive screening test in community patients. Further studies are
needed to evaluate the accuracy and usefulness of the Mini-Cog and to
compare it with other simple cognitive screening tests.(9)
- The Instrumental Activities Lawton-Brody for the activities of daily
living (IADL) is a test used to assess the ability of individuals to
perform different independent daily living skills, of varying
difficulties. It covers eight functional areas: use of the telephone,
shopping, preparing food, domestic work, laundry, using transport,
medical care, and finances. The maximum level of points for men is 5
points, whereas in women it is 8 points.(10)
Analysis
of data
A descriptive statistical analysis was conducted in which continuous
variables were expressed as mean ± SD or median (interquartile range -
IQR). Categorical variables were described as frequencies and
percentages. On the other hand, a bivariate analysis was applied to
evaluate the differences in continuous data between two groups (Yes / No
MCI) using nonparametric Mann-Whitney U test. Also, to compare
categorical data the Fisher exact test or χ2 test was used, as suitable.
Finally, we conducted a predictive multivariate logistic regression
analysis to estimate possible risk factors predicting MCI in the study
population. The initial multivariate model used all variables with
p≤0,200 in the bivariate analysis. Variables were excluded from the
final multivariate logistic regression model based on likelihood ratio
test results. Degree of agreement between the MoCA / MoCA B and mini-cog
tools used for MCI detection was assessed using the Kappa statistic. The
software used was STATA/SE software version 12 (11).