Lower Cutoff Points for Montreal Cognitive Assessment Needed

High false-positive rate seen when used in primary care with diverse patient population

By Lori Solomon HealthDay Reporter

WEDNESDAY, Jan. 17, 2024 (HealthDay News) — The Montreal Cognitive Assessment (MoCA) cutpoints for identifying mild cognitive impairment (MCI) or dementia are inappropriately high in a diverse community setting, yielding a high false-positive rate, according to a study published online Jan. 10 in the Journal of the American Geriatrics Society.

Marnina B. Stimmel, Ph.D., from Albert Einstein College of Medicine in New York City, and colleagues examined the utility and discriminative validity of the Spanish and English MoCA versions to identify cognitive impairment among diverse community-dwelling older adults. The analysis included 231 older adults (aged 65 years and older; 43 percent Hispanic and 39 percent Black/African American) with cognitive concerns attending outpatient primary care.

The researchers found that neuropsychological assessment identified 90 participants as cognitively normal with subjective cognitive concerns (average MoCA, 19.9), 133 with MCI (average MoCA, 16.6), and eight with dementia (average MoCA, 10.6). The mean English MoCA average was 18.6 versus 16.7 for Spanish. There was a high false-positive rate using the published cutpoint â¤23 for MCI (79 percent). Using the English MoCA, â¤18.5 was identified as the score to identify MCI or dementia (65 percent sensitivity; 77 percent specificity) and â¤16.5 for the Spanish MoCA (64 percent sensitivity; 73 percent specificity).

“Lower Spanish and English MoCA cutpoints may improve diagnostic accuracy for identifying cognitive impairment in this group, highlighting the need for the creation and validation of accurate cognitive screeners for ethnoculturally and linguistically diverse older adults,” the authors write.

One author disclosed ties to MedRhythms.

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