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Optimal cutoffs for the Montreal Cognitive Assessment vary by race and ethnicity

Sadaf Arefi Milani1, Michael Marsiske2, Linda B Cottler1

  • 1Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA.

Alzheimer'S & Dementia (Amsterdam, Netherlands)
|December 4, 2018
PubMed
Abstract

Insights

The Montreal Cognitive Assessment (MoCA) cutoff score of 26 may not be optimal for all racial/ethnic groups. Stratified cutoffs for MoCA screening are needed for accurate detection of mild cognitive impairment (MCI) and dementia.

Area of Science:

  • Neurology
  • Gerontology
  • Public Health

Background:

  • The Montreal Cognitive Assessment (MoCA) is a widely used screening tool for mild cognitive impairment (MCI).
  • The standard MoCA cutoff score of 26 may exhibit ethnic and educational biases.
  • Optimizing MoCA cutoffs is crucial for equitable cognitive health assessments.

Purpose of the Study:

  • To determine optimal cutoff scores for the MoCA to detect mild cognitive impairment (MCI) and dementia.
  • To investigate whether these optimal cutoffs vary by race/ethnicity and educational attainment.
  • To improve the accuracy and fairness of cognitive screening tools.

Main Methods:

  • Utilized data from the National Alzheimer's Coordinating Center Uniform Data Set (March 2018 data freeze).
  • Calculated optimal MoCA cutoffs for identifying MCI and dementia across different racial/ethnic groups and education levels.
  • Included 3895 individuals in the analysis.

Main Results:

  • Optimal MoCA cutoffs for MCI detection varied by race/ethnicity: 25 for non-Hispanic Whites, 24 for Hispanics, and 23 for non-Hispanic Blacks.
  • Optimal MoCA cutoffs for dementia detection were 19 for non-Hispanic Whites and 16 for non-Hispanic Blacks and Hispanics.
  • Lower educational attainment correlated with lower optimal MoCA cutoff scores.

Conclusions:

  • Current MoCA cutoffs may not be universally applicable across diverse populations.
  • Stratifying MoCA cutoffs by race/ethnicity and education is recommended for accurate diagnosis.
  • Adjusted cutoffs can enhance the detection of MCI and dementia in clinical practice.
Keywords:
Alzheimer's diseaseDementiaDisparitiesEducationEthnicityMontreal Cognitive AssessmentRaceScreening

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