Validation and Convergent Validity of the Boston Cognitive Assessment (BOCA) in an Italian Population: A Comparative Study with the Montreal Cognitive Assessment (MoCA) in Alzheimer’s Disease Spectrum

Abstract

Background: The Boston Cognitive Assessment (BOCA) is a self-administered online test developed for cognitive screening and longitudinal monitoring of brain health in an aging population. The study aimed to validate BOCA in an Italian population and to investigate the convergent validity with the Montreal Cognitive Assessment (MOCA) in normal controls and subjects within the Alzheimer Disease spectrum. Methods: BOCA was administered to 150 participants, including cognitively healthy controls (HC, n=50), patients with mild cognitive impairment (MCI, n=50), and dementia (DEM, n=50). The BOCA reliability was assessed using i) Spearman s correlation analysis between subscales; ii) Cronbach s alpha calculation, and iii) Principal Component Analysis. Repeated-measures ANOVA was employed to assess the impact of the sequence of test administrations between the groups. BOCA performance between HS, MCI and DEM were compared using Kruskall Wallis test. Furthermore, a comparison was conducted between MCI patients who tested positive for amyloid and those who tested negative, utilizing Mann Whitney s U-test. Results: Test scores were significantly different between patients and controls (p<0.001) suggesting good discriminative ability. The Cronbach s alpha was 0.82 indicating a good internal consistency of the BOCA subscales and strong-to-moderate Spearman s correlation coefficients between them. BOCA demonstrated strong correlation with Montreal Cognitive Assessment (MoCA) (rho=0.790, p<0.001). Conclusions: The Italian version of the BOCA test exhibited validity, feasibility, and accurate discrimination.