Validation of the Argentine version of the Montreal Cognitive Assessment Test (MOCA): A screening tool for Mild Cognitive Impairment and Mild Dementia in Elderly

Abstract

<jats:p>ABSTRACT. The MoCA is a brief useful test to diagnose mild cognitive impairment (MCI) and mild dementia (MD). To date, no Argentine cross-cultural adapted validations of the Spanish version have been reported. Objective: To validate the MoCA in the elderly and study its usefulness in MCI and MD. Methods: This study included 399 individuals over 60 years old evaluated in the Cognitive-Behavioral Department (2017-2018). Patients with&lt;3 years of education, sensory disturbances, psychiatric disorders, or moderate-severe dementia were excluded. The control group comprised cognitively normal subjects. Participants were classified according to neuropsychological assessment and clinical standard criteria into Control, MCI or MD groups. A locally adapted MoCA (MOCA-A) was administered to the patients and controls. Results: Mean educational level was 10.34 years (SD 3.5 years). MoCA-A score differed significantly among groups (p&lt;0.0001). MoCA-A performance correlated with educational level (r: 0.406 p&lt;0.00001). Adopting a cut-off score ≥25 (YI=0.55), the sensitivity for MCI was 84.8% and for MD 100%, with specificity of 69.7%. When adding a single point to the score in patients with ≤12 years of education, the specificity of the test reached 81%. Conclusion: The MoCA-A is an accurate reliable screening test for MCI and MD in Argentina.</jats:p>

Impact of Educational Level on Versions (Basic and Complete) of the Montreal Cognitive Assessment

“…In addition, results show that on both versions of the MoCA, educational level influences performance coinciding with several studies [20, 23, 28, 30-32]. More importantly, results show that the MoCA Basic continues to be affected by education level in spite of the author’s intentions [35].…”

“…The MoCA Full shows a sensitivity of 90% and a specificity of 87% for MCI, and a sensitivity of 100% with a specificity of 87% for mild-stage Alzheimer’s dementia, using a cutoff point of 26 [14]. Similar results have been observed in several studies [5, 9, 13, 16, 17, 20, 23, 25, 36, 37].…”

“…One of the most widely used brief assessment instruments is the Mini-Mental State Examination (MMSE) [14]. However, recent studies have found that it is not as sensitive in assessing MCI [5,[15][16][17][18][19] and early dementia as the Montreal Cognitive Assessment (MoCA), for which studies identify greater sensitivity and specificity to detect the stages mentioned above [13,[20][21][22][23][24][25].…”

“…For >50 years, it has been known that performance on brief assessment instruments is influenced by different sociodemographic variables [26]. Specifically, age and ed-ucational level are the variables that have the greatest effect on performance; test scores decrease with age and increase with educational level [23,[27][28][29][30][31][32][33][34]. The MoCA Full was validated in a population with high educational levels, with an average of approximately 13 years of education [15].…”

Mild cognitive impairment history and current procedures in low- and middle-income countries: a brief review

“… 23 In Argentina, MoCA was found to have good accuracy in identifying both MCI and dementia, but it is influenced by educational level. 26 In fact, more comprehensive analyses show MoCA as more suitable for screening for dementia than for MCI. 27 , 28 In Brazil, one study also found that MoCA is the most recommended tool to screen for dementia, but it is not so accurate when screening for cognitive decline before a dementia diagnosis or for low educational levels.…”