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).