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. 2018 Dec;26(12):1258-1267.
doi: 10.1016/j.jagp.2018.09.009. Epub 2018 Sep 21.

Effects of Normative Adjustments to the Montreal Cognitive Assessment

Erika A Pugh  1 , Emily C Kemp  2 , Christopher H van Dyck  3 , Adam P Mecca  2 , Emily S Sharp  4 ; Alzheimer's Disease Neuroimaging Initiative
Affiliations

Effects of Normative Adjustments to the Montreal Cognitive Assessment

Erika A Pugh et al. Am J Geriatr Psychiatry. 2018 Dec.

Abstract

Objective: To investigate optimal cutoff scores and the effects of normative adjustments on the performance of the Montreal Cognitive Assessment (MoCA) as a screening instrument for Mild Cognitive Impairment (MCI) and dementia due to Alzheimer's disease (AD-dementia).

Methods: 499 adults 48 to 91 years-old enrolled in the Alzheimer's Disease Neuroimaging Initiative (ADNI) and were administered the MoCA during baseline. Participants were classified as either cognitively normal (CN), MCI, or AD-dementia by clinical assessment. Receiver operating characteristic (ROC) analyses were performed using raw MoCA scores, education-adjusted MoCA scores, and a regression-based adjustment derived from the National Alzheimer's Coordinating Center data (NACC). Test performance characteristics were calculated for various cutoffs after each normative correction method.

Results: Areas under the curve (AUC) were similar for raw, education-adjusted, and NACC-adjusted MoCA scores, and demonstrated minimal improvement when adjustments of increasing complexity were applied. Our results suggest that the optimal cutoff score for distinguising MCI is 24 and for distinguising AD-dementia is 22.

Conclusions: This study adds to the understanding of how normative adjustments affect the sensitivity and specificity of the MoCA. Suggested corrections based on education alone do not yield improved test characteristics, but small improvements are attained when a regression-based correction that accounts for age, sex, and education is applied. Furthermore, optimal cutoffs for distinguishing CN from MCI or CN from AD-dementia were lower than previously reported. Optimal cutoffs to detect MCI and AD-dementia may vary in different populations, and further study is needed to determine appropriate use of the MoCA as a screening tool.

Keywords: ADNI; Alzheimer's disease; MoCA; dementia; mild cognitive impairment.

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Figures

Figure 1.
Figure 1.. ROC plots of baseline MoCA scores with various normative adjustments applied.
Areas under the curve (AUC) were similar for ROC curves constructed with uncorrected MoCA scores, education adjusted scores, and NACC adjusted scores. There was a slight improvement when adjustments of increasing complexity were applied.
See this image and copyright information in PMC

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