Differential Relationships Between the Montreal Cognitive Assessment and Informant-Rated Cognitive Decline Among Mexican Americans and Non-Hispanic Whites

Abstract

Objectives: We compared the concurrent validity of the Montreal Cognitive Assessment (MoCA) with other cognitive screening instruments among Mexican Americans (MA) and non-Hispanic whites (NHW). Methods: In a community-based study in Nueces county, Texas (5/2/18-2/26/20), participants 65+ with MoCA ≤25 completed the Harmonized Cognitive Assessment Protocol. Regressions examined associations between MoCA and: 1) Mini Mental State Examination (MMSE); 2) abbreviated Community Screening Interview for Dementia (CSI-D); 3) Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: MA (n = 229) and NHW (n = 81) differed by education but not age or sex. MoCA and cognitive performance associations (MMSE, CSI-D-Respondent) did not differ between MA and NHW (p’s > .16). MoCA and informant rating associations (IQCODE, CSI-D-Informant) were stronger in NHW than MA (NHW R2 = 0.39 and 0.38, respectively; MA R2 = 0.30 and 0.28, respectively). Discussion: Our findings suggest non-equivalence across cognitive screening instruments among MAs and NHWs.

Tracking cognition with the T‐MoCA in a racially/ethnically diverse older adult cohort

“…In contrast, NH‐W participants, who performed the highest at baseline, remained largely stable from waves 1–3. Consistent with existing literature, 13 , 14 , 15 , 16 this suggests that the lower scores observed at baseline in NH‐B and Hispanic older adults likely reflects a culture‐related test bias of the MoCA, which may yield artificially reduced scores in minoritized groups that are not necessarily predictive of cognitive decline (see 27 for a discussion of cross‐cultural test bias). Of note, our study suggests that with repeated exposure to the MoCA, scores more closely approximate those of NH‐Ws.…”

“…Our findings of racial/ethnic differences in performance on the T‐MoCA are consistent with the established literature. MoCA scores associate with numerous demographic variables, including race/ethnicity, 13 , 14 , 15 , 16 age, 18 , 28 educational background and literacy, 13 , 17 , 18 , 28 , 29 and psychiatric factors. 19 Although literature on the T‐MoCA is still emerging, research suggests that age, 7 , 10 race/ethnicity, 7 , 10 education, 7 , 12 , 22 and gender 7 can impact T‐MoCA performance.…”

“…After wave 3, our findings showed that any effects of practice or regression to the mean reached an equilibrium, and subsequent trajec- Our findings of racial/ethnic differences in performance on the T-MoCA are consistent with the established literature. MoCA scores associate with numerous demographic variables, including race/ethnicity, [13][14][15][16] age, 18,28 educational background and literacy, 13,17,18,28,29 and psychiatric factors. 19 Although literature on the T-MoCA is still emerging, research suggests that age, 7,10 race/ethnicity, 7,10 education, 7,12,22 and gender 7 We also found that the T-MoCA is relatively less reliable than the in-person MoCA version.…”

“…Studies investigating test‐retest reliability of the T‐MoCA and its capacity to track cognition over time are lacking. It is well‐established that race/ethnicity is associated with MoCA performance 13–16 ; however, little is known of whether there are racial/ethnic differences in changes in T‐MoCA performance over time. Given that remote screeners are increasingly utilized to track cognition, there is a critical need to investigate the serial use of the T‐MoCA and its utility for clinical monitoring in ethnically/racially diverse groups, controlling for factors that have been shown to be associated with MoCA including age, education, and depression 13,17–19 …”

Differential Impact of Stroke on Cognitive Impairment in Mexican Americans and Non-Hispanic White Americans

“…33,46,47 This is an area of ongoing research within the BASIC-Cognitive project. 48,49 Additionally, we relied on self-report for ascertainment of medical history variables and stroke history, which may have been impacted by recall bias, though self-reported stroke has been determined to be a valid measure of clinical stroke history. 28 As we did not have clinical records, we were unable to assess stroke severity, stroke recurrence, or stroke mechanism, which have been shown to predict poststroke cognitive outcomes.…”