Discriminative Ability of Montreal Cognitive Assessment Subtests and Items in Racial and Ethnic Minority Groups

Abstract

Introduction: The Montreal Cognitive Assessment (MoCA) is a popular screening tool for Mild Cognitive Impairment (MCI). The psychometric properties of the MoCA have not been widely examined in minority groups. We aimed to analyze the discriminate ability of subtests and items by race and ethnicity given gold-standard clinical diagnosis of cognitive status. Methods: Data come from the National Alzheimer's Coordinating Center Uniform Data Set March 2018 data freeze. Stepwise regression was used to determine which subtests predicted cognitive status (normal cognition, MCI, or dementia), by race/ethnicity. Item discrimination and difficulty was calculated by race/ethnicity and cognitive status. Results: In our sample (n=3,895), with an average age of 69.7, 80.7% were non-Hispanic White, 15.0% were non-Hispanic Black, and 4.2% were Hispanic. Among non-Hispanic Whites all subtests, education, and age predicted clinician diagnosis, while visuospatial/executive, attention, language, delayed recall, and orientation subtests were predictive among non-Hispanic Blacks and visuospatial/executive, delayed recall, and orientation subtests and education were predictive among Hispanics. Item discrimination and difficulty varied by race ethnicity and cognitive status. Conclusions: By understanding the psychometric properties of MoCA subtests, we can focus on subtests that have higher discrimination and more diagnostic utility. Subtests should be further evaluated for use in screening of minority individuals.

Normative and Equated Data of the Original and Basic Versions of the Montreal Cognitive Assessment among Community Dwelling Saudi Arabians

“…In comparison to studies that included minorities and differing ethnicities [ 3 , 53 , 54 ], the overall pattern of item difficulty was similar, with recall of all 5 words being amongst the most difficult. This is an important finding to consider when interpreting the delayed recall responses, reviewing the performance of cued recall gives additional unscored information on the likely cause of the memory impairment.…”

Bilingualism, assessment language, and the Montreal Cognitive Assessment in Mexican Americans

“…Differential difficulty of the MoCA across language would have important implications for interpretation of cognition outcomes using the MoCA across English and Spanish speakers. The MoCA and its component sub‐scores may be less predictive of consensus diagnosis of dementia in Latinx older adults as compared to non‐Hispanic whites, and use of cut‐scores validated in non‐Hispanic white populations may over‐classify impairment in Latinx populations 18,19 . Future work is needed to confirm psychometric equivalence of the MoCA across English and Spanish.…”

A Spanish Neuropsychological Battery Discriminates Between the Behavioral Variant of Frontotemporal Dementia and Primary Progressive Aphasia in a Colombian Sample

“…Other previous studies included MoCA subtests like Milani et al ( 29 ) who found in a large sample study that, among Hispanics, the MoCA subtests had higher discrimination and more diagnostic utility ( 29 ). Similarly to our study, another study analyzed the capability of subtest from a cognitive battery to contribute to differential diagnosis in dementia.…”