Background/Aims: Mild cognitive impairment (MCI) is frequent in Parkinson’s disease (PD) and idiopathic REM sleep behavior disorder (iRBD). However, only a few studies have evaluated the validity of brief cognitive measures to detect MCI in PD or iRBD using standard diagnostic criteria for MCI. Our aim was to evaluate the validity of the Mini-Mental State Examination (MMSE) and the Mattis Dementia Rating Scale (DRS-2) to detect MCI in PD and iRBD. Methods: Forty PD patients and 34 iRBD patients were studied. Receiver operating characteristic curves were created for both tests to assess their effectiveness in identifying MCI in PD and iRBD. Results: In PD, a normality cutoff of 138 on the DRS-2 yielded the best balance between sensitivity (72%) and specificity (86%) with a correct classification of 80%. In iRBD, the optimal normality cutoff was 141 on the DRS-2, with a sensitivity of 90%, a specificity of 71% and a correct classification of 82%. No cutoff for the MMSE was found to have acceptable sensitivity or specificity. Conclusion: The DRS-2 has satisfactory validity to detect MCI in PD or iRBD. The MMSE proved to be invalid as a screening test for MCI in both populations.

de Lau LM, Schipper CM, Hofman A, Koudstaal PJ, Breteler MM: Prognosis of Parkinson disease: risk of dementia and mortali- ty – the Rotterdam Study. Arch Neurol 2005;62:1265–1269.
Aarsland D, Andersen K, Larsen JP, Lolk A, Nielsen H, Kragh-Sørensen P: Risk of dementia in Parkinson’s disease: a community-based, prospective study. Neurology 2001;56:730–736.
Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K, Belleville S, Brodaty H, Bennett D, Chertkow H, Cummings JL, de Leon M, Feldman H, Ganguli M, Hampel H, Scheltens P, Tierney MC, Whitehouse P, Winblad B, International Psychogeriatric Association Expert Conference on Mild Cognitive Impairment: Mild cognitive impairment. Lancet 2006;367:1262–1270.
Janvin CC, Larsen JP, Aarsland D, Hugdahl K: Subtypes of mild cognitive impairment in Parkinson’s disease: progression to dementia. Mov Disord 2006;21:1343–1349.
Aarsland D, Bronnick K, Williams-Gray C, Weintraub D, Marder K, Kulisevsky J, Burn D, Barone P, Pagonabarraga J, Allcock L, Santangelo G, Foltynie T, Janvin C, Larsen JP, Barker RA, Emre M: Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis. Neurology 2010;75:1062–1069.
Caviness JN, Driver-Dunckley E, Connor DJ, Sabbagh MN, Hentz JG, Noble B, Evidente VG, Shill HA, Adler CH: Defining mild cognitive impairment in Parkinson’s disease. Mov Disord 2007;22:1272–1277.
Mamikonyan E, Moberg PJ, Siderowf A, Duda JE, Have TT, Hurtig HI, Stern MB, Weintraub D: Mild cognitive impairment is common in Parkinson’s disease patients with normal Mini-Mental State Examination (MMSE) scores. Parkinsonism Relat Disord 2009;15:226–231.
Folstein MF, Folstein SE, McHugh PR: ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
Dubois B, Brun D, Goetz C: Diagnostic procedures for Parkinson’s disease dementia: recommendations from the Movement Disorder Society Task Force. Mov Disord 2007;22:2314–2324.
Feher EP, Mahurin RK, Doody RS, Cooke N, Sims J, Pirozzolo JF: Establishing the limits of the Mini-Mental State: examination of ‘subtests’. Arch Neurol 1992;49:87–92.
Tröster AI: Neuropsychological characteristics of dementia with Lewy bodies and Parkinson’s disease with dementia: differentiation, early detection, and implications for ‘mild cognitive impairment’ and biomarkers. Neuropsychol Rev 2008;18:103–119.
Athey RJ, Porter RW, Walker RW: Cognitive assessment of a representative community population with Parkinson’s disease (PD) using the Cambridge Cognitive Assessment-Revised (CAMCOG-R). Age Ageing 2005;34:268–273.
Nazem S, Siderowf AD, Duda JE, Have TT, Colcher A, Horn SS, Moberg PJ, Wilkinson JR, Hurtig HI, Stern MB, Weintraub D: Montreal Cognitive Assessment performance in patients with Parkinson’s disease with ‘normal’ global cognition according to Mini-Mental State Examination score. J Am Geriatr Soc 2009;57:304–308.
Gill DJ, Freshman A, Blender JA, Ravina B: The Montreal Cognitive Assessment as a screening tool for cognitive impairment in Parkinson’s disease. Mov Disord 2008;23:1043–1046.
Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB, Weintraub D: Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology 2009;73:1738–1745.
Zadikoff C, Fox SH, Tang-Wai DF, Thomsen T, de Bie RM, Wadia P, Miyasaki J, Duff-Canning S, Lang AE, Marras C: A comparison of the Mini-Mental State Exam to the Montreal Cognitive Assessment in identifying cognitive deficits in Parkinson’s disease. Mov Disord 2008;23:297–299.
Mattis S: Dementia Rating Scale. Professional Manual. Odessa, Psychological Assessment Resources, 1988.
Paolo AM, Tröster AI, Glatt SL, Hubble JP, Koller WC: Differentiation of the dementias of Alzheimer’s and Parkinson’s disease with the Dementia Rating Scale. J Geriatr Psychiatry Neurol 1995;8:184–188.
Llebaria G, Pagonabarraga J, Kulisevsky J, García-Sánchez C, Pascual-Sedano B, Gironell A, Martínez-Corral M: Cut-off score of the Mattis Dementia Rating Scale for screening dementia in Parkinson’s disease. Mov Disord 2008;23:1546–1550.
American Academy of Sleep Medicine: The International Classification of Sleep Disorders. Diagnostic and Coding Manual, ed 2. Westchester, American Academy of Sleep Medicine, 2005.
Gagnon JF, Postuma RB, Mazza S, Doyon J, Montplaisir J: Rapid-eye-movement sleep behaviour disorder and neurodegenerative diseases. Lancet Neurol 2006;5:424–432.
Gagnon JF, Vendette M, Postuma RB, Desjardins C, Massicotte-Marquez J, Panisset M, Montplaisir J: Mild cognitive impairment in rapid eye movement behavior disorder and Parkinson’s disease. Ann Neurol 2009;66:39–47.
Gagnon JF, Postuma RB, Joncas S, Desjardins C, Latreille V: The Montreal Cognitive Assessment: a screening tool for mild cognitive impairment in REM sleep behavior disorder. Mov Disord 2010;25:936–940.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4, text rev. Washington, American Psychiatric Association, 2000.
Gibb WR, Lees AJ: The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 1988;51:745–752.
Hoehn M, Yahr M: Parkinsonism: onset, progression and mortality. Neurology 1967;17:427–442.
Fahn S, Elton R, Members of the UPDRS Development Committee: Unified Parkinson’s Disease Rating Scale; in Fahn S, Marsden CD, Calne DB, Goldstein M (eds): Recent Developments in Parkinson’s Disease. New York, Macmillan, 1987, vol 2, pp 153–163.
Hobson DE, Lang AE, Martin WR, Razmy A, Rivest J, Fleming J: Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: a survey by the Canadian Movement Disorders Group. JAMA 2002;287:455–463.
Pedraza O, Lucas JA, Smith GE, Petersen RC, Graff-Radford NR, Ivnik RJ: Robust and expanded norms for the Dementia Rating Scale. Arch Clin Neuropsychol 2010;25:347–358.
Crum RM, Anthony JC, Bassett SS, Folstein MF: Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA 1993;269:2386–2391.
Hudon C, Potvin O, Turcotte MC, D’Anjou C, Dubé M, Préville M, Brassard J: Normative date [sic!] for the Mini-Mental State Examination (MMSE) in a sample of community dwelling French speaking residents from Quebec aged 65 and older (in French). Can J Aging 2009;28:347–357.
Bohnen N, Jolles J, Twijnstra A: Modification of the Stroop Color Word Test improves differentiation between patients with mild head injury and matched controls. Clin Neuropsychol 1992;6:178–184.
Strauss E, Sherman EM, Spreen O: A Compendium of Neuropsychological Tests. Administration Norms and Commentary, ed 3. New York, Oxford University Press, 2006.
Petersen RC, Morris JC: Mild cognitive impairment as a clinical entity and treatment target. Arch Neurol 2005;62:1160–1163.
Broadbent DE, Cooper PF, FitzGerald P, Parkes KR: The Cognitive Failures Questionnaire (CFQ) and its correlates. Br J Clin Psychol 1982;21:1–16.
Aarsland D, Litvan I, Salmon D, Galasko D, Wentzel-Larsen T, Larsen JP: Performance on the Dementia Rating Scale in Parkinson’s disease with dementia and dementia with Lewy bodies: comparison with progressive supranuclear palsy and Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2003;74:1215–1220.
Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG: The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord 2008;23:837–844.
Buter TC, van den Hout A, Matthews FE, Larsen JP, Brayne C, Aarsland D: Dementia and survival in Parkinson disease: a 12-year population study. Neurology 2008;70:1017–1022.
Schenck CH, Bundlie SR, Mahowald MW: Delayed emergence of parkinsonian disorder in 39% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology 1996;46:388–393.
Postuma RB, Gagnon JF, Vendette M, Fantini ML, Massicotte-Marquez J, Montplaisir J: Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behaviour disorder. Neurology 2009;72:1296–1300.
Iranzo A, Molinuevo JL, Santamaria J, Serradell M, Martí MJ, Valldeoriola F, Tolosa E: Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol 2006;5:572–577.
Belleville S: Cognitive training for persons with mild cognitive impairment. Int Psychogeriatr 2008;20:57–66.
Matteau, E, Simard M, Jean L, Turgeon Y: Detection of mild cognitive impairment using cognitive screening tests: a critical review and preliminary data on the Mattis Dementia Rating Scale; in Tsai JP (ed): Leading-Edge Cognitive Disorder Research. Hauppauge, Nova Science Publishers, 2008, pp 9–58.
Shiroky JS, Schipper HM, Bergman H, Cherkow H: Can you have dementia with an MMSE score of 30? Am J Alzheimers Dis Other Demen 2007;22:406–415.
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H: The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695–699.
Dalrymple-Alford JC, MacAskill MR, Nakas CT, Livingston L, Graham C, Crucian GP, Melzer TR, Kirwan J, Keenan R, Wells S, Porter RJ, Watts R, Anderson TJ: The MoCA: well-suited screen for cognitive impairment in Parkinson disease. Neurology 2010;75:1717–1725.
Brown GG, Rahill AA, Gorell JM, McDonald C, Brown SJ, Sillanpaa M, Shults C: Validity of the Dementia Rating Scale in assessing cognitive function in Parkinson’s disease. J Geriatr Psychiatry Neurol 1999;12:180–188.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.