The Montreal Cognitive Assessment at the Framingham Heart Study: A Re-Examination of the Norms

There is a lack of consensus regarding what constitutes cognitively normal performance on the Montreal Cognitive Assessment (MoCA) based on demographic characteristics. Further, research regarding normative data on the MoCA for middle-aged individuals is relatively limited. The current study sought to provide age- and education-corrected normative data for the MoCA in a large epidemiological cohort of cognitively healthy middle-aged and older adults with characteristics similar to the original validation sample of the MoCA.

Participants were from Generation 3 and Omni 2 cohorts of the Framingham Heart Study (n = 2637; 91.43% non-Hispanic White) who were determined to be cognitively unimpaired at the time of MoCA assessment (Mean age = 53.56 years, age range = 32-83 years, 63.71% ≥ college-educated). Normative data were generated by age in 10-year intervals and education (≤ high school, some college, or ≥ college degree). Analysis of variance was used to examine the relationship between MoCA performance, age, and education.

The average MoCA score across all participants was close to the revised MCI cutoff of 23 (M = 24.69, SD = 3.03). The average MoCA score for individuals over the age of 60 was below the recently suggested MCI cutoff score of 23 points. Similarly, individuals above the age of 70 scored below the revised cutoff score of 23 points, irrespective of level of education. Further, performance of participants below the age of 40 who were college educated was similar to the frequently used original MCI cutoff score of 26 (M = 26.28, SD = 2.41).

Results are consistent with previous literature suggesting that the original MoCA cutoff score of 26 may result in a high rate of false positives. Findings indicate that the recently suggested MCI cutoff score of 23 on the MoCA may also be artificially high. Using inappropriate normative data for the MoCA can impact diagnostic accuracy as well as misclassification in research settings. These findings highlight the need for the use of demographically appropriate, population-based normative data for the MoCA in clinical and research settings.