Normative Data of Mini-Mental State Examination, Montreal Cognitive Assessment, and Alzheimer’s Disease Assessment Scale-Cognitive Subscale of Community-Dwelling Older Adults in Taiwan

Abstract

<b><i>Introduction:</i></b> Appropriate tools and references are essential for evaluating individuals’ cognitive levels. This study validated the Taiwan version of the Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-cog) and provided normative data for the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and ADAS-cog in community-dwelling older adults. <b><i>Methods:</i></b> MMSE, MoCA, and ADAS-cog were administered to 150 nondemented healthy adults aged 55–85 years during 2018–2020 as part of the Northeastern Taiwan Community Medicine Research Cohort. ADAS-cog was translated from the original English version to traditional Chinese with cultural and language considerations in Taiwan. Cronbach’s alpha (α) tested the reliability of ADAS-cog, and Pearson correlations examined its external validity using MMSE and MoCA as comparisons. Normative data were generated and stratified by age and education, and the one-way analysis of variance compared scores between age and education groups. Another 20 hospital-acquired participants with cognitive impairment joined the 150 healthy participants. Comparisons in the Clinical Dementia Rating (CDR) tiers tested the discriminability of the tests for different cognitive levels. The area under the receiver operating characteristic curve (AUROC) analyzed the power of ADAS-cog in predicting CDR 0.5 from CDR 0. <b><i>Results:</i></b> The Taiwan version of ADAS-cog had fair reliability between items (α = 0.727) and good correlations to MMSE (<i>r</i> = −0.673, <i>p</i> < 0.001) and MoCA (<i>r</i> = −0.746, <i>p</i> < 0.001). The normative data of MMSE, MoCA, and ADAS-cog showed ladder changes with age (<i>p</i> = 0.006, 0.001, and 0.437) and education (<i>p</i> < 0.001, <0.001, and <0.001) in the 150 nondemented older adults. Next, in the 170 mixed participants from the communities and the hospital, MMSE, MoCA, and ADAS-cog scores were well differentiable between CDR 0, 0.5, and 1. In addition, ADAS-cog discriminated CDR 0.5 from 0 by an AUROC of 0.827 (<i>p</i> < 0.001). <b><i>Discussion/Conclusion:</i></b> The three structured cognitive tests consistently reflect cognitive levels of healthy older adults. The Taiwan version of ADAS-cog is compatible with MMSE and MoCA to distinguish people with mildly impaired from normal cognition. In addition, this study derived MMSE, MoCA, and ADAS-cog norms tailored to demographic factors. The findings highlight the need for stratification of age and education rather than applying a fixed cutoff for defining normal and abnormal cognition.

White matter alterations and their associations with biomarkers and behavior in subjective cognitive decline individuals: a fixel-based analysis

“…5 ), suggesting a functional–anatomical coupling. Our previous study revealed significant decreases in local dynamic functional connectivity at the right IPL in SCD compared to normal controls [ 55 ]. Because the IPL is at the origin of SLFII, the functional connectivity decreased at IPL in SCD might be linked with the macrostructural changes at SLFII.…”

“…5 Anatomical overlap of right IPL and SLFII. Comparing the regions of interest (ROIs) with local dynamic connectivity difference [ 55 ] and the fixels with FBA metrics of fiber cross-section difference between SCD and NC, the right inferior parietal lobe ROI (yellow dot) [ 91 ] is anatomically co-localized with the SLFII fiber bundles (red-gradient area) [ 90 ]. The methods of generating this figure are available in Supplementary 1 …”

“…The cognitive assessments included two structured cognitive tests for global cognition, the MoCA [ 51 , 52 ] and the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog) [ 53 – 55 ] in traditional Chinese. Additional tests for testing specific cognitive domains were the Digit Symbol Substitution Test (DSST), the Digit Span Test (DST), the Category Fluency (CF), the Letter-Number Sequencing (LNS), and the Facial Memory Test (FMT) from the Wechsler Adult Intelligence Scale-III [ 56 ].…”

Age-related differences in understanding pronominal reference in sentence comprehension: An electrophysiological investigation.

“…All participants took the Taiwan Mandarin versions of the Mini-Mental State Examination (MMSE; Folstein et al, 1975; Wei et al, 2022), the Reading Span test (Daneman & Carpenter, 1980; Friedman & Miyake, 2004), and the Print Exposure test (the Author Recognition test and the Magazine Recognition test; Acheson et al, 2008; Stanovich & West, 1989). Table 1 presents the sample means, standard deviations, and correlations for age, years of education, and these neuropsychological measures.…”

Cluster analysis dissecting cognitive deficits in older adults with major depressive disorder and the association with neurofilament light chain

“…Cognitive deficit was obtained through MMSE, using the 30-point version. The MMSE has been widely used to screen cognitive impairment in community settings and had renewed normative data in Taiwan [ 26 , 32 ]. The examination had been carried out by trained researchers.…”