Design: Cross-sectional study.Setting: Cognition clinic and memory clinic of a public hospital in Hong Kong.Participants: A total of 272 participants (dementia, n=130; mild cognitive impairment, n=93; normal controls, n=49) aged 60 years or above were assessed using HK-MoCA. The HK-MoCA scores were validated against expert diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed) criteria for dementia and Petersen's criteria for mild cognitive impairment. Statistical analysis was performed using receiver operating characteristic curve and regression analyses. Additionally, comparison was made with the Cantonese version of Mini-Mental State Examination and Global Deterioration Scale. Results:The optimal cutoff score for the HK-MoCA to differentiate cognitive impaired persons (mild cognitive impairment and dementia) from normal controls was 21/22 after adjustment of education level, giving a sensitivity of 0.928, specificity of 0.735, and area under the curve of 0.920. Moreover, the cutoff to detect mild cognitive impairment was 21/22 with a sensitivity of 0.828, specificity of 0. • It is a reasonably good screening tool for mild cognitive impairment with comparable efficacy with the Cantonese version of Mini-Mental State Examination (MMSE). Implications for clinical practice or policy • HK-MoCA is brief and feasible to conduct in the clinical setting, and can be completed in less than 15 minutes.• HK-MoCA provides an attractive screening instrument in place of MMSE which has ceiling effect and needs to be purchased due to copyright issues.

Background and Purpose: The study evaluated the performance between norm-derived age and education adjusted vs single cutoff scores of the Montreal Cognitive Assessment, Hong Kong version (HK-MoCA) in classifying cognitive impairment in Chinese older adults. Methods: Total scores of HK-MoCA were collected from 315 subjects (128 with dementia, 122 with mild cognitive impairment (MCI) and 65 normal) attending a public district hospital-based cognition clinic from 2012 to 2017. The HK-MoCA total scores were evaluated using different cutoffs. Norm-derived age and education adjusted cutoff scores were at 16th, 7th, and 2nd percentiles. Comparison was made with the single cutoff scores validated in a local study with 21/22 for MCI and 18/19 for dementia. Results: Single cutoff score of HK-MoCA differentiated MCI from normal with sensitivity of 0.861 and specificity of 0.723. To detect dementia, its sensitivity was 0.922, and specificity was 0.923. In identifying cognitive impairment, the sensitivity and specificity were 0.932 and 0.723, respectively. However, age and education adjusted cutoff scores achieved high specificities at all levels of cognitive impairment with trade-off of sensitivities. The accuracy of correctly classifying tested subjects into appropriate groups was 85.3% if single cutoff was used though the consistency between norm-derived cutoffs and expert diagnoses were only 59.0%, 54.2%, and 53.9% at 16th, 7th, and 2nd percentiles, respectively. The consistency decreased with older age and lower education level, and majority of misclassifications were false negatives. Conclusion: HK-MoCA is a convenient screening tool to detect cognitive impairment. Administration time is relatively short, and it has incorporated essential cognitive domains. Single cutoff scores with inherent simple education adjustment achieved screening purpose of mild cognitive impairment and dementia in Chinese older adults.

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review by a third clinician. Results: The median age at diagnosis of RPD was 69 years. 72% of patients were female. Symptoms began 1.2 [0.2-6.3] years prior to assessment, with an accelerated annualized rate of change in Clinical Dementia Rating Sum of ). Modifying diagnoses were present in 17/47 (36%): most commonly, cerebrovascular disease (43%) and mood disorders (29%). Investigations routinely included neuroimaging (in all patients; 94% MRI), serum thyroid/B 12 studies (77%), CSF analysis (51%), and electroencephalogram (32%). Additional CSF testing for AD-and CJD-biomarkers was completed in 16 (34%) and 15 (32%) patients. AD-biomarkers were consistent with AD in 12 (75%) cases, including 2 patients with PPCD and one with cerebral amyloid angiopathy with inflammation. CJD-biomarkers were not indicative of CJD in any patient. Conclusions: Common neurodegenerative dementing illnesses may present as RPD and can be reliably diagnosed using widely-available diagnostic tools. Measurement of AD and CJD biomarkers in the CSF may further inform the differential diagnosis for patients in whom the diagnosis remains uncertain.