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Comparative Study
. 2015;29(4):413-25.
doi: 10.1080/13854046.2015.1043349. Epub 2015 May 15.

An Abbreviated Montreal Cognitive Assessment (MoCA) for Dementia Screening

Daniel K Horton  1 , Linda S Hynan, Laura H Lacritz, Heidi C Rossetti, Myron F Weiner, C Munro Cullum
Affiliations
Comparative Study

An Abbreviated Montreal Cognitive Assessment (MoCA) for Dementia Screening

Daniel K Horton et al. Clin Neuropsychol. 2015.

Abstract

Objective: The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument growing in popularity, but few studies have conducted psychometric item analyses or attempted to develop abbreviated forms. We sought to derive and validate a short-form MoCA (SF-MoCA) and compare its classification accuracy to the standard MoCA and Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI), Alzheimer disease (AD), and normal aging.

Methods: 408 subjects (MCI n = 169, AD n = 87, and normal n = 152) were randomly divided into derivation and validation samples. Item analysis in the derivation sample identified most sensitive MoCA items. Receiver Operating Characteristic (ROC) analyses were used to develop cut-off scores and evaluate the classification accuracy of the SF-MoCA, standard MoCA, and MMSE. Net Reclassification Improvement (NRI) analyses and comparison of ROC curves were used to compare classification accuracy of the three measures.

Results: Serial subtraction (Cramer's V = .408), delayed recall (Cramer's V = .702), and orientation items (Cramer's V = .832) were included in the SF-MoCA based on largest effect sizes in item analyses. Results revealed 72.6% classification accuracy of the SF-MoCA, compared with 71.9% for the standard MoCA and 67.4% for the MMSE. Results of NRI analyses and ROC curve comparisons revealed that classification accuracy of the SF-MoCA was comparable to the standard version and generally superior to the MMSE.

Conclusions: Findings suggest the SF-MoCA could be an effective brief tool in detecting cognitive impairment.

Keywords: Alzheimer’s disease; Cognitive screening; Mild cognitive impairment; Montreal Cognitive Assessment.; Short form.

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Figures

Figure 1
Figure 1
Receiver Operating Characteristic (ROC) curves for the SF-MoCA, Standard MoCA, and MMSE in differentiating controls from the cognitively impaired group (MCI+AD) in the derivation sample. MCI = Mild Cognitive Impairment; AD = Alzheimer Disease; MoCA = Montreal Cognitive Assessment; SF-MoCA = Short-Form Montreal Cognitive Assessment; MMSE = Mini Mental State Examination.
Figure 2
Figure 2
Receiver Operating Characteristic (ROC) curves for the SF-MoCA, Standard MoCA, and MMSE in differentiating AD from the remainder of the derivation sample (NC+MCI). NC = Normal Control; MCI = Mild Cognitive Impairment; AD = Alzheimer Disease; MoCA = Montreal Cognitive Assessment; SF-MoCA = Short-Form Montreal Cognitive Assessment; MMSE = Mini Mental State Examination.
Figure 3
Figure 3
Receiver Operating Characteristic (ROC) curves for the SF-MoCA, Standard MoCA, and MMSE in differentiating controls from the cognitively impaired group (MCI+AD) in the validation sample. MCI = Mild Cognitive Impairment; AD = Alzheimer Disease; MoCA = Montreal Cognitive Assessment; SF-MoCA = Short-Form Montreal Cognitive Assessment; MMSE = Mini Mental State Examination.
Figure 4
Figure 4
Receiver Operating Characteristic (ROC) curves for the SF-MoCA, Standard MoCA, and MMSE in differentiating AD from the remainder of the validation sample (NC+MCI). NC = Normal Control; MCI = Mild Cognitive Impairment; AD = Alzheimer Disease; MoCA = Montreal Cognitive Assessment; SF-MoCA = Short-Form Montreal Cognitive Assessment; MMSE = Mini Mental State Examination.
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