Which behavioral health screening tool should you use—and when?

The MoCA is a simple, standalone cognitive screening tool validated for adults ages 55 to 85 years.³³ The MoCA addresses many important cognitive domains, fits on one page, and can be administered by a trained provider in 10 minutes. Research also suggests that it has strong test-retest reliability and positive and negative predictive values for mild cognitive impairment and Alzheimer dementia, and it has been found to be more sensitive than the MMSE.³⁴ We additionally recommend the MoCA as it measures several cognitive skills that are not addressed on the MMSE, including verbal fluency and abstraction.³⁴ Scores below 25 are suggestive of cognitive impairment and should lead to a referral for neuropsychological testing.

The MoCA’s sensitivity for detecting cognitive impairment is high (94%), and specificity is low (42%).³⁵ To ensure consistency and accuracy in administering the MoCA, certification is now required via an online training program through www.mocatest.org.

Adapting these screening tools to practice

These tools are not meant to be used at every appointment. Every practice is different, and each clinic or physician can tailor the use of these screening tools to the needs of the patient population, as concerns arise, or in collaboration with other providers. Additionally, these screening tools can be used in both integrated care and in private practice, to prompt a more thorough assessment or to aid in—and inform—treatment. Although some physicians choose to administer certain screening tools at each clinic visit, knowing about the availability of other tools can be useful in ­assessing various issues.

The FIGURE can be used to aid in the clinical decision-making process.

CORRESPONDENCE
Rebecca Sewell, PsyD, Bon Secours Mercy Health, 2213 Cherry Street, Toledo, OH 4360; rebecca.sewell30@gmail.com.