Effects of Normative Adjustments to the Montreal Cognitive Assessment

Abstract

Objective: To investigate optimal cutoff scores and the effects of normative adjustments on the performance of the Montreal Cognitive Assessment (MoCA) as a screening instrument for Mild Cognitive Impairment (MCI) and dementia due to Alzheimer’s disease (AD-dementia). Methods: 499 adults 48 to 91 years-old enrolled in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) and were administered the MoCA during baseline. Participants were classified as either cognitively normal (CN), MCI, or AD-dementia by clinical assessment. Receiver operating characteristic (ROC) analyses were performed using raw MoCA scores, education-adjusted MoCA scores, and a regression-based adjustment derived from the National Alzheimer’s Coordinating Center data (NACC). Test performance characteristics were calculated for various cutoffs after each normative correction method. Results: Areas under the curve (AUC) were similar for raw, education-adjusted, and NACC-adjusted MoCA scores, and demonstrated minimal improvement when adjustments of increasing complexity were applied. Youden’s index indicated that the optimal cutoff score may be lower than the established cutoff of 26. Conclusions: This study adds to the understanding of how normative adjustments affect the sensitivity and specificity of the MoCA. Suggested corrections based on education alone do not yield improved test characteristics, but small improvements are attained when a regression-based correction that accounts for age, sex, and education is applied. Furthermore, optimal cutoffs for distinguishing CN from MCI or CN from AD-dementia were lower than previously reported. Optimal cutoffs to detect MCI and AD-dementia may vary in different populations, and further study is needed to determine appropriate use of the MoCA as a screening tool.

Diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) for cognitive screening in old age psychiatry: Determining cutoff scores in clinical practice. Avoiding spectrum bias caused by healthy controls

“…Our findings are in line with the literature, where lower cutoff scores are repeatedly suggested 18,19,[38][39][40]42,43,47 to tackle this problem. Our findings are in line with the literature, where lower cutoff scores are repeatedly suggested 18,19,[38][39][40]42,43,47 to tackle this problem.…”

“…There was no significant difference between sex (P = . 39) and education length (P = .142). Disability, as measured by the GAF, showed an expected difference: MCI best and the demented and NoCI (as most of them were psychiatrically ill) the worst GAF score (P = .001).…”

“…The "optimum" cutoff scores against NoCI as calculated by the Younden index were less than 25 for detecting MCI, sensitivity 88% (95% CI, 81-92), specificity 49% (95% CI, 44-53); less than 23 for CI, sensitivity 75% (95% CI, 69-81), specificity 68% (95% CI, 63-72); and less than 21 for MD, sensitivity 90% (95% CI, 81-95), specificity 78% (95% CI, 74-81) and comparable with literature. [39][40][41][42][43] The PPV and NPV were calculated (…”

Gait and balance disturbances are common in young urbanites and associated with cognitive impairment. Air pollution and the historical development of Alzheimer's disease in the young

“… 36 , 37 MoCA covers several cognitive domains including episodic memory, language, attention, orientation, visuospatial and executive functions and has been validated in Mexican populations. 49 , 50 , 51 , 52 , 53…”

The items in the Chinese version of the Montreal Cognitive Assessment Basic discriminate among different severities of Alzheimer’s disease

“…The cutoff points to detect MCI or AD have been demonstrated to be different all over the world [6][7][8][9].…”