Montreal Cognitive Assessment — Single Cutoff Achieves Screening Purpose

Figures & data

Table 1 Age and Education Corrected Normative Data of Total Score of MoCA.⁶

	Education	Cutoff at Percentile
		16th	7th	2nd
Age 65–69 years	0–3	17	14	9
	4–6	19	18	13
	7–9	21	19	16
	10–12	22	20	17
	>12	25	23	21
		16th	7th	2nd
Age 70–79 years	0–3	15	14	11
	4–6	18	15	10
	7–9	20	18	15
	10–12	22	19	18
	>12	22	20	16
		16th	7th	2nd
Age ≥ 80 years	0–6	13	13	10
	>6	17	15	13

Notes: Impairment is determined when score ≤age and education corrected percentile cutoff. Reproduced with permission from Wong A, Law SN, Liu WY, et al. Montreal cognitive assessment one cutoff never fits all. Stroke. 2015;46(12):3547–355. Available from: https://www.ahajournals.org/doi/10.1161/STROKEAHA.115.011226?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed .6

Table 2 Demographic Characteristics by Cognition Groups

Demographic Characteristics	NC (n=65)	MCI (n=122)	Dementia (n=128)	Total (n=315)	F	p-value
Gender					–	χ2=5.170; p=0.075
Female	36 (55.4%)	62 (50.8%)	74 (57.8%)	172 (54.6%)
Male	29 (44.6%)	60 (49.2%)	54 (42.2%)	143 (45.4%)
Age, years						<0.001*
<70	21 (32.3%)	25 (20.5%)	11 (8.6%)	57 (18.1%)
70–79	28 (43.1%)	47 (38.5%)	47 (36.7%)	122 (38.7%)
≥80	16 (24.6%)	50 (41.0%)	70 (54.7%)	136 (43.2%)
Average age	73.20±8.43	77.22±7.97	79.50±6.84	77.32±7.96	14.704
Years of education						<0.001*
0–3	18 (27.7%)	56 (45.9%)	82 (64.0%)	156 (49.5%)
4–6	18 (27.7%)	25 (20.5%)	26 (20.3%)	69 (21.9%)
7–9	11 (16.9%)	18 (14.8%)	13 (10.2%)	42 (13.3%)
10–12	9 (13.8%)	16 (13.1%)	3 (2.4%)	28 (8.9%)
≥12	9 (13.8%)	7 (5.7%)	4 (3.1%)	20 (6.4%)
Average years	6.91±4.98	5.28±4.68	3.24±4.02	4.79±4.70	15.549
HK-MoCA total score	23.86±5.40	17.32±4.31	12.15±3.93	16.57±6.21	155.032	<0.001*
CMMSE total score	27.06±2.67	21.84±3.99	17.00±3.92	20.94±5.32	163.348	<0.001*

Notes: Data are shown as frequency (percentage) while average values are expressed as mean ±SD. *Significant at 0.05.

Abbreviations: NC, normal controls; MCI, mild cognitive impairment; HK-MoCA, Montreal Cognitive Assessment, Hong Kong version; CMMSE, Mini-Mental State Examination, Cantonese version.

Table 3 Diagnostic Power Comparisons Between Different Cutoffs in MCI and Dementia Subjects

	Sensitivity (95%CI)	Specificity (95%CI)	AUC (95%CI)	p-value
MCI vs normal				0.000^*,a
Single cutoff (21/22)	0.861 (0.786, 0.917)	0.723 (0.598, 0.827)	0.792 (0.719, 0.865)
7th percentile	0.287 (0.209, 0.376)	0.969 (0.893, 0.996)	0.628 (0.549, 0.707)
16th percentile	0.410 (0.322, 0.503)	0.908 (0.810, 0.965)	0.659 (0.581, 0.737)
Dementia vs normal				<0.000*
Single cutoff (18/19)	0.922 (0.861, 0.962)	0.923 (0.830, 0.975)	0.922 (0.876, 0.969)
2nd percentile	0.359 (0.276, 0.442)	0.985 (0.917, 1.000)	0.672 (0.598, 0.746)
Cognitive Impairment^b vs normal				0.000^*,a
Single cutoff (21/22)	0.932 (0.893, 0.960)	0.723 (0.598, 0.827)	0.828 (0.760, 0.895)
7th percentile	0.496 (0.432, 0.560)	0.969 (0.893, 0.996)	0.733 (0.675, 0.790)
16th percentile	0.572 (0.508, 0.634)	0.908 (0.810, 0.965)	0.740 (0.680, 0.800)

Notes: *Significant at 0.05. ^aSingle cutoff is significantly higher than both 7th and 16th percentiles. ^bCognitive impairment (MCI + dementia).

Abbreviations: AUC, area under curve; MCI, mild cognitive impairment.

Figure 1 Classification of agreement of norm-derived age and education adjusted cutoff scores of HK-MoCA with expert diagnoses at different percentiles.

Wong A, Law SN, Liu WY, et al. Montreal cognitive assessment one cutoff never fits all. Stroke. 2015;46(12):3547–3550. doi:10.1161/strokeaha.115.01122626470772

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