Montreal Cognitive Assessment for screening mild cognitive impairment: variations in test performance and scores by education in Singapore.


Journal Article

The Montreal Cognitive Assessment (MoCA) was developed as a screening instrument for mild cognitive impairment (MCI). We evaluated the MoCA's test performance by educational groups among older Singaporean Chinese adults.The MoCA and Mini-Mental State Examination (MMSE) were evaluated in two independent studies (clinic-based sample and community-based sample) of MCI and normal cognition (NC) controls, using receiver operating characteristic curve analyses: area under the curve (AUC), sensitivity (Sn), and specificity (Sp).The MoCA modestly discriminated MCI from NC in both study samples (AUC = 0.63 and 0.65): Sn = 0.64 and Sp = 0.36 at a cut-off of 28/29 in the clinic-based sample, and Sn = 0.65 and Sp = 0.55 at a cut-off of 22/23 in the community-based sample. The MoCA's test performance was least satisfactory in the highest (>6 years) education group: AUC = 0.50 (p = 0.98), Sn = 0.54, and Sp = 0.51 at a cut-off of 27/28. Overall, the MoCA's test performance was not better than that of the MMSE. In multivariate analyses controlling for age and gender, MCI diagnosis was associated with a <1-point decrement in MoCA score (η(2) = 0.010), but lower (1-6 years) and no education was associated with a 3- to 5-point decrement (η(2) = 0.115 and η(2) = 0.162, respectively).The MoCA's ability to discriminate MCI from NC was modest in this Chinese population, because it was far more sensitive to the effect of education than MCI diagnosis.

Full Text

Cited Authors

  • Ng, TP; Feng, L; Lim, WS; Chong, MS; Lee, TS; Yap, KB; Tsoi, T; Liew, TM; Gao, Q; Collinson, S; Kandiah, N; Yap, P

Published Date

  • January 6, 2015

Published In

Volume / Issue

  • 39 / 3-4

Start / End Page

  • 176 - 185

PubMed ID

  • 25572449

Pubmed Central ID

  • 25572449

Electronic International Standard Serial Number (EISSN)

  • 1421-9824

International Standard Serial Number (ISSN)

  • 1420-8008

Digital Object Identifier (DOI)

  • 10.1159/000368827


  • eng