Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US

Abstract

Objective: Cross validation study of the MoCA for the detection of Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI) in a community-based cohort residing in the Southeastern United States.

Methods: One hundred and eighteen English-speaking older adults, who underwent diagnostic evaluation as part of an on-going prospective study, were administered the MoCA and MMSE. Twenty were diagnosed with AD, 24 met criteria for amnestic MCI and 74 were considered cognitively normal. Sensitivities and specificities were calculated using the recommended cut-off scores and ROC curve analyses were performed to determine optimal sensitivity and specificity. The influence of age, education and gender on MoCA score was also examined.

Results: Using a cut-off score of 24 or below, the MMSE was insensitive to cognitive impairment. Using the recommended cut-off score of 26, the MoCA detected 97% of those with cognitive impairment but specificity was fair (35%). Using a lower cut-off score of 23, the MoCA exhibited excellent sensitivity (96%) and specificity (95%).

Conclusion: The MoCA appears to have utility as a cognitive screen for early detection of AD and for MCI and warrants further investigation regarding its applicability in primary care settings, varying ethnic groups, and younger at-risk individuals.