Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-22T18:33:53.840Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychometrics of the Montreal Cognitive Assessment (MoCA) and its subscales: validation of the Taiwanese version of the MoCA and an item response theory analysis

Published online by Cambridge University Press:  12 December 2011

Chia-Fen Tsai ,
Wei-Ju Lee ,
Shuu-Jiun Wang ,
Ben-Chang Shia ,
Ziad Nasreddine  and
Jong-Ling Fuh
Chia-Fen Tsai
Affiliation:
Department of Psychiatry, Neurological Institute, Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University Schools of Medicine, Taipei, Taiwan Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
Wei-Ju Lee
Affiliation:
Institute of Clinical Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
Shuu-Jiun Wang
Affiliation:
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
Ben-Chang Shia
Affiliation:
Department of Statistics and Information Science, Fu-Jen Catholic University, Taipei, Taiwan
Ziad Nasreddine
Affiliation:
Center for Clinical Research, Neurology Service, University of Sherbrooke, Hôpital Charles LeMoyne, Sherbrooke, Quebec, Canada
Jong-Ling Fuh*
Affiliation:
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
*
Correspondence should be addressed to: Dr. Jong-Ling Fuh, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, 112. Phone: +886-2-28762522; Fax: +886-2-28765215. Email: [email protected].
Get access

Abstract

Background: The Montreal Cognitive Assessment (MoCA) is an instrument for screening mild cognitive impairment (MCI). This study examined the psychometric properties and the validity of the Taiwan version of the MoCA (MoCA-T) in an elderly outpatient population.

Methods: Participants completed the MoCA-T, Mini-Mental State Examination (MMSE), and the Chinese Version Verbal Learning Test. The diagnosis of Alzheimer's disease (AD) was made based on the NINCDS-ADRDA criteria, and MCI was diagnosed through the criteria proposed by Petersen et al. (2001).

Results: Data were collected from 207 participants (115 males/92 females, mean age: 77.3 ± 7.5 years). Ninety-eight participants were diagnosed with AD, 71 with MCI, and 38 were normal controls. The area under the receiver operator curves (AUC) for predicting AD was 0.98 (95% confidence interval [CI] = 0.97–1.00) for the MMSE, and 0.99 (95% CI = 0.98–1.00) for the MoCA-T. The AUC for predicting MCI was 0.81 (95% CI = 0.72–0.89) using the MMSE and 0.91 (95% CI = 0.86–1.00) using the MoCA-T. Using an optimal cut-off score of 23/24, the MoCA-T had a sensitivity of 92% and specificity of 78% for MCI. Item response theory analysis indicated that the level of information provided by each subtest of the MoCA-T was consistent. The frontal and language subscales provided higher discriminating power than the other subscales in the detection of MCI.

Conclusion: Compared to the MMSE, the MoCA-T provides better psychometric properties in the detection of MCI. The utility of the MoCA-T is optimal in mild to moderate cognitive dysfunction.

Keywords

The Montreal Cognitive AssessmentAlzheimer's diseasemild cognitive impairmentvalidationitem response theory
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 4 , April 2012 , pp. 651 - 658
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bruscoli, M. and Lovestone, S. (2004). Is MCI really just early dementia? A systematic review of conversion studies. International Psychogeriatrics, 16, 129–140.Google Scholar
Chang, C. C. et al. (2010). Validating the Chinese version of the verbal learning test for screening Alzheimer's disease. Journal of the International Neuropsychological Society, 16, 244–251.Google Scholar
Doody, R. S. et al. (2009). Donepezil treatment of patients with MCI: a 48-week randomized placebo-controlled trial. Neurology, 72, 1555–1561.Google Scholar
Dubois, B. and Albert, M. L. (2004). Amnestic MCI or prodromal Alzheimer's disease? The Lancet Neurology, 3, 246–248.Google Scholar
Emberson, S. E. and Reise, S. P. (2000). Item Response Theory for Psychologists. Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Minimental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Fujiwara, Y. et al. (2010). Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment. Geriatrics and Gerontology International, 10, 225–232.Google Scholar
Gagnon, L. G. and Belleville, S. (2011). Working memory in mild cognitive impairment and Alzheimer's disease: contribution of forgetting and predictive value of complex span tasks. Neuropsychology, 25, 226–236.Google Scholar
Gill, D. J., Freshman, A., Blender, J. A. and Ravina, B. (2008). The Montreal Cognitive Assessment as a screening tool for cognitive impairment in Parkinson's disease. Movement Disorder, 23, 1043–1046.Google Scholar
Hambleton, R. K., Swaminathan, H. and Rogers, H. J. (1991). Fundamentals of Item Response Theory. Newbury Park, CA: Sage Publications.Google Scholar
Kramer, J. H. et al. (2006). Multiple cognitive deficits in amnestic mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 22, 306–311.Google Scholar
Kurt, P., Yener, G. and Oguz, M. (2011). Impaired digit span can predict further cognitive decline in older people with subjective memory complaint: a preliminary result. Aging and Mental Health, 15, 364–369.Google Scholar
Lee, J. Y. et al. (2008). Brief screening for mild cognitive impairment in elderly outpatient clinic: validation of the Korean version of the Montreal Cognitive Assessment. Journal of Geriatric Psychiatry and Neurology, 21, 104–110.Google Scholar
Lu, L. and Bigler, E. D. (2002). Normative data on trail making test for neurologically normal, Chinese-speaking adults. Applied Neuropsychology, 9, 219–225.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease. Report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939–944.Google Scholar
Nasreddine, Z. S. et al. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695–699.Google Scholar
Oishi, S. (2007). The application of structural equation modeling and item response theory to cross-cultural positive psychology research. In Ong, A. D. and Van Dulmen, M. H. M. (eds.), Oxford Handbook of Methods in Positive Psychology (pp. 126–138) New York: Oxford University Press.Google Scholar
Olson, R. A., Chhanabhai, T. and McKenzie, M. (2008). Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases. Supportive Care in Cancer, 16, 1273–1278.Google Scholar
Perry, R. J., Watson, P. and Hodges, J. R. (2000). The nature and staging of attention dysfunction in early (minimal and mild) Alzheimer's disease: relationship to episodic and semantic memory impairment. Neuropsychologia, 38, 252–271.Google Scholar
Petersen, R. C. (2004). Mild underlying cognitive dysfunction as a diagnostic entity. Journal of Internal Medicine, 256, 183–194.CrossRefGoogle Scholar
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303–308.Google Scholar
Petersen, R. C. et al. (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58, 1985–1992.Google Scholar
Reitan, R. M. (1959). Validity of the trail making test as an indication of organic brain damage. Perceptual and Motor Skills, 8, 271–276.Google Scholar
Saunders, N. L. and Summers, M. J. (2011). Longitudinal deficits to attention, executive, and working memory in subtypes of mild cognitive impairment. Neuropsychology, 25, 237–248.Google Scholar
Scherbaum, C. A., Cohen-Charash, Y. and Kern, M. J. (2006). Measuring general self-efficacy: a comparison of three measures using item response theory. Educational and Psychological Measurement, 66, 1047–1063.Google Scholar
Smith, G. E., Petersen, R. C., Parisi, J. E. and Ivnik, R. J. (1996). Definition, course, and outcome of mild cognitive impairment. Aging, Neuropsychology, and Cognition, 3, 141–147.Google Scholar
Tobinick, E. L. and Gross, H. (2008). Rapid cognitive improvement in Alzheimer's disease following perispinal etanercept administration. Journal of Neuroinflammation, 5, 2. doi:10.1186/1742-2094-5-2.CrossRefGoogle Scholar
Traykov, L. et al. (2007). Executive functions deficit in mild cognitive impairment. Cognitive and Behavioral Neurology, 20, 219–224.Google Scholar
Vakil, E. and Blachstein, H. (1993). Rey auditory-verbal learning test: structure analysis. Journal of Clinical Psychology, 49, 883–890.Google Scholar
Wong, A. et al. (2009). The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dementia and Geriatric Cognitive Disorders, 28, 81–87.Google Scholar