Related Experiment Video
Updated: Jan 3, 2026
Dynamic Digital Biomarkers of Motor and Cognitive Function in Parkinson's Disease
Published on: July 24, 2019
Factor structure of the Montreal Cognitive Assessment in Parkinson disease
Callum R Smith1, Jonathan Cavanagh2, Matthew Sheridan3
1Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
Objectives:
The Montreal Cognitive Assessment (MoCA) is a common tool for screening mild cognitive impairment (MCI) and dementia. Studies in multiple clinical groups provide evidence for various factor structures mapping to different cognitive domains. We tested the factor structure of the MoCA in a large cohort of early Parkinson disease (PD).
Materials And Methods:
Complete MoCA data were available from an observational cohort study for 1738 patients with recent-onset PD (64.6% male, mean age 67.6, SD 9.2). Confirmatory factor analysis (CFA) was applied to test previously defined two-factor, six-factor, and three-factor models in the full sample and in a subgroup with possible cognitive impairment (MoCA < 26). Secondary analysis used exploratory factor analysis (EFA; principal factors with oblique rotation).
Results:
The mean MoCA score was 25.3 (SD 3.4, range 10-30). Fit statistics in the six-factor model (χ2 /df 17.77, root mean square error of approximation [RMSEA] 0.10, comparative fit index [CFI] 0.74, Tucker-Lewis index [TLI] 0.69, standardised root mean square residual [SRMR] 0.07) indicated poorer fit than did previous studies. Findings were similar in the two-factor and three-factor models. EFA suggested an alternative six-factor solution (short-term recall, visuospatial-executive, attention/working memory, verbal-executive, orientation, and expressive language), although CFA did not support the validity of the new model.
Conclusions:
The factor structure of the MoCA in early PD was not consistent with that of previous research. This may reflect higher cognitive performance and differing demographics in our sample. The results do not support a clear, clinically relevant factor structure in an early PD group, suggesting that the MoCA should be followed with detailed assessment to obtain domain-specific cognitive profiles.
Insights
The Montreal Cognitive Assessment (MoCA) factor structure differs in early Parkinson disease (PD) patients compared to other groups. This suggests detailed cognitive assessments are needed for PD patients, not just the MoCA screening tool.
Area of Science:
- Neuroscience
- Cognitive Psychology
- Clinical Neurology
Background:
- The Montreal Cognitive Assessment (MoCA) is widely used to screen for mild cognitive impairment (MCI) and dementia.
- Previous studies established various factor structures for the MoCA across different clinical populations.
- The cognitive profile in early Parkinson disease (PD) requires specific evaluation.
Purpose of the Study:
- To investigate the factor structure of the MoCA in a large cohort of patients with early Parkinson disease (PD).
- To determine if established MoCA factor models are applicable to individuals with recent-onset PD.
- To explore alternative factor structures using exploratory factor analysis.
Main Methods:
- Confirmatory factor analysis (CFA) was used to test existing two-, three-, and six-factor MoCA models in 1738 early PD patients.
- Analysis was conducted on the full sample and a subgroup with possible cognitive impairment (MoCA < 26).
- Exploratory factor analysis (EFA) was employed for secondary analysis to identify potential alternative structures.
Main Results:
- The tested MoCA factor models showed a poor fit in the early PD cohort, contrasting with findings in other populations.
- Confirmatory factor analysis did not support the validity of previously defined or newly suggested factor structures.
- Exploratory factor analysis indicated a potential six-factor solution, but its validity was not confirmed by CFA.
Conclusions:
- The MoCA's factor structure in early Parkinson disease is not consistent with prior research.
- The findings suggest the MoCA alone may not provide a clinically relevant, domain-specific cognitive profile in early PD.
- Further detailed neuropsychological assessments are recommended for individuals with early PD to accurately profile cognitive function.
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