Psychometric Properties of the Montreal Cognitive Assessment (MoCA) in Spanish Adults

The Montreal Cognitive Assessment (MoCA) is widely used for cognitive screening, but its dimensionality and domain-specific accuracy require validation with methods for ordinal items. The objective was to analyze the internal structure of the MoCA in a cognitive impairment-free Spanish community sample and examine its relationship with variables potentially related to the risk of cognitive impairment.

A total of 1,767 Spanish adults (aged 18-89 years) were assessed in primary care centers using the MoCA, and sociodemographic and health variables were recorded. Internal structure and metric properties were analyzed using factor models and item response theory, as well as their association with external variables and the concordance of the resulting solution.

The theoretical models tested did not demonstrate adequate fit. Cross-validation identified a 12-item solution in two correlated factors (Memory and Multiple), with excellent fit (CFI = .991; RMSEA = .019) and latent correlation r = .63. The abbreviated version showed high concordance with the total score (ICC = .96) and substantial agreement in dichotomous classification (k = .84).

The MoCA exhibited a two-factor structure and consistent associations with external variables such as age, educational level, and vascular risk; a dimensional interpretation is recommended.