Use of the Montreal Cognitive Assessment (MoCA) in a Rural Outreach Program for Military Veterans

Area of Science:

• Gerontology
• Public Health
• Cognitive Science

Background:

• The Montreal Cognitive Assessment (MoCA) is a widely used cognitive screening tool.
• Its accessibility makes it suitable for resource-limited rural settings.
• Veteran Community Outreach Health Workers (VCOHWs) provide essential services to rural Veterans.

Purpose of the Study:

• To evaluate the administration and scoring accuracy of the MoCA by VCOHWs.
• To compare cognitive screening rates using different MoCA cutoff scores.
• To identify predictors of MoCA performance in rural Veterans.

Main Methods:

• The study involved 168 rural military Veterans from the Alabama Veteran Rural Health Initiative.
• Administration and scoring fidelity of the MoCA by VCOHWs were assessed.
• Statistical analyses examined screening rates and predictors of education-adjusted MoCA scores.

Main Results:

• MoCA administration accuracy was high (95%), but scoring accuracy was lower (68%).
• A significant proportion of Veterans screened positive (40% using a 24/30 cutoff).
• Age, education, and race were significant predictors of MoCA scores, while subjective health was not.

Conclusions:

• The MoCA is a viable cognitive screening tool for rural Veterans, adaptable for use by VCOHWs.
• Recommendations are provided to improve MoCA scoring fidelity among healthcare workers.
• This research provides novel insights into cognitive screening within a rural Deep South Veteran population.