MoCA Overestimates Dementia in Diverse Patients

Educational Objectives

Summary

Montreal Cognitive Assessment Overestimates Cognitive Impairment in a Diverse Population

The 30-point Montreal Cognitive Assessment (MoCA) is used commonly in primary care practices to screen for cognitive impairment. Because the MoCA has been determined to be influenced by education and cultural factors, its developers added a 1-point education correction, but whether that adjustment is sufficient is unclear.

In a study in the Journal of the American Geriatrics Society (https://doi.org/10.1111/jgs.18705), researchers analyzed results of the MoCA and complete neurocognitive assessments in 231 community-dwelling older adults (age, ≥65) with memory concerns in the Bronx, NY, who were enrolled in a randomized trial of another brief cognitive assessment. Among the study population, 42% identified as Hispanic and 39% as African American; 51% chose to have their MoCA assessments in Spanish. On average, those electing English and Spanish MoCAs had 12.6 years and 9.8 years of education, respectively.

The gold-standard full neurocognitive assessment classified 39% of patients as having normal cognition, 58% as having mild cognitive impairment (MCI), and 3% as having dementia. In contrast, the distribution of these categories with the MoCA (using cutpoints with the 1-point educational correction) were markedly different — 10%, 52%, and 38% of patients, respectively. Optimal sensitivity and specificity for cognitive impairment (MCI or dementia) was achieved when the MoCA cutpoint was set at 16.5 (far below the standard 23 or 24 that usually is employed).

Published MoCA cutpoints yielded false-positive rates of 32% for any cognitive impairment and 92% for dementia in this racially, ethnically, and culturally diverse population. Overdiagnosis of cognitive impairment could stigmatize patients unnecessarily and inappropriately overburden limited memory services in underserved communities. Clinicians therefore should be cautious in interpreting MoCA results in diverse populations.

Bruce Soloway, MD

Readings

Disclosures

Dr. Marnina Stimmel reported having no financial conflicts of interest.

Acknowledgements

CME/CE INFO

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Lecture ID:

JW350910

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