Is Montreal Cognitive Assessment for cognitive screening accurate in diverse populations? Study sheds light
USA: A recent study published in the Journal of the American Geriatrics Society has pointed out the inappropriately high current Montreal Cognitive Assessment (MoCA) in a culturally/linguistically diverse urban setting, leading to a high false-positive rate.
The researchers revealed that lower English and Spanish MoCA cutpoints may improve diagnostic accuracy for identifying cognitive impairment in this group. This highlights the need for the creation and validation of accurate cognitive screeners for linguistically and ethnoculturally diverse older adults.
"A screening tool often used in primary care clinics to detect cognitive impairment has shortcomings when applied to ethnically and linguistically diverse older adults," the study stated.
The study looked to see whether currently published English and Spanish cut points for cognitive impairment in the Montreal Cognitive Assessment (MoCA) are appropriate in diverse community-based adults aged 65 years or older with cognitive concerns in the Bronx, New York. There were 231 participants (43% Hispanic, 39% Black/African American); 49% completed testing in English and 51% in Spanish.
Investigators found that the MoCA cut points for indicating mild cognitive impairment or dementia were inappropriately high, as compared with gold standard neuropsychological testing, with a high false-positive rate for detecting cognitive impairment.
Key findings were as follows:
- Neuropsychological assessment identified 90 as cognitively normal/SCC, average MoCA of 19.9 (SD = 4.1), 133 with MCI, an average MoCA of 16.6 (SD = 3.7), and 8 with dementia, with an average MoCA of 10.6 (SD = 3.1).
- The mean English MoCA average was 18.6 (SD = 4.1) versus Spanish 16.7 (SD = 4.3).
- The published cutpoint ≤23 for MCI yielded a high false-positive rate (79%).
- ROC analyses identified ≤18.5 as the score to identify MCI or dementia using the English MoCA (65% sensitivity; 77% specificity) and ≤16.5 for the Spanish MoCA (64% sensitivity;73% specificity) in this sample of older adults with cognitive concerns.
“These findings underscore the importance of considering cultural factors and social determinants of health when evaluating performances on cognitive screening tools such as the MoCA, particularly in traditionally underserved communities,” said corresponding author Marnina Stimmel, PhD, of the Montefiore Health System and Albert Einstein College of Medicine.
Reference:
Marnina B. Stimmel, Ariela R. Orkaby, Emmeline Ayers, Joe Verghese, Celeste K. Nsubayi, Erica F. Weiss, Is the Montreal cognitive assessment culturally valid in a diverse geriatric primary care setting? Lessons from the Bronx, Journal of the American Geriatrics Society, https://doi.org/10.1111/jgs.18705.
