Montreal Cognitive Assessment (MoCA) Norms for Older Patients with a Depressive Disorder

Background: Interpretation of cognitive performance in older patients with depression is challenging considering the association between late-life depression and (early-stage) neurodegenerative disease. The Montreal Cognitive Assessment (MoCA) is widely used to screen for mild cognitive impairment in community-dwelling older adults. Objective: The aim of the present study was to examine the need for and to develop dedicated MoCA norms for older people with depressive disorder. Methods: We used data from the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) study and the Advanced Neuropsychological Diagnostics Infrastructure (ANDI) database, which consisted of 859 patients with a depressive disorder according to DSM-5 criteria and 320 healthy controls, aged ≥60 years. Linear regression was used to examine the relationship between late-life depression and MoCA scores, adjusted for age, sex, and education. Results: The presence of a depressive disorder was associated with lower MoCA scores, and this effect was larger for persons with 12 years or less of education than for those with more education (B = -0.76 [95% CI -0.61; -0.91] vs. -0.53 [-0.36; -0.70]). Among depressed patients, depressive symptom severity was not associated with the MoCA score. Regression-based normative data for the MoCA were computed and adjusted for age, education, sex, and type of depressive disorder. Conclusions: Our findings demonstrate that depressive disorder, but not symptom severity within depression, is associated with lower MoCA scores. Clinical interpretation of MoCA scores in depressed older persons can be facilitated by using MoCA reference tables stratified by age, sex and level of education.