Adrian Wong1, Lorraine S N Law1, Wenyan Liu1, Zhaolu Wang1, Eugene S K Lo1, Alexander Lau1, Lawrence K S Wong1, Vincent C T Mok2. 1. From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China. 2. From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China vctmok@cuhk.edu.hk.
Abstract
BACKGROUND AND PURPOSE: The objective of this study is to examine the discrepancy between single versus age and education corrected cutoff scores in classifying performance on the Montreal Cognitive Assessment (MoCA) in patients with stroke or transient ischemic attack. METHODS: MoCA norms were collected from 794 functionally independent and stroke- and dementia-free persons aged ≥65 years. magnetic resonance imaging was used to exclude healthy controls with significant brain pathology and medial temporal lobe atrophy. Cutoff scores at 16th, 7th, and 2nd percentiles by age and education were derived for the MoCA and MoCA 5-minute Protocol. MoCA performance in 919 patients with stroke or transient ischemic attack was classified using the single and norm-derived cutoff scores. RESULTS: The norms for the Hong Kong version of the MoCA total and domain scores and the total score of the MoCA 5-minute protocol are described. Only 65.1% and 25.7% healthy controls and 45.2% and 19.0% patients scored above the conventional cutoff scores of 21/22 and 25/26 on the MoCA. Using classification with norm-derived cutoff scores as reference, locally derived cutoff score of 21/22 yielded a classification discrepancy of ≤42.4%. Discrepancy increased with higher age and lower education level, with the majority being false positives by single cutoffs. With the 25/26 cutoff of the original MoCA, discrepancy further increased to ≤74.3%. CONCLUSIONS: Conventional single cutoff scores are associated with substantially high rates of misclassification especially in older and less-educated patients with stroke. These results caution against the use of one-size-fits-all cutoffs on the MoCA.
BACKGROUND AND PURPOSE: The objective of this study is to examine the discrepancy between single versus age and education corrected cutoff scores in classifying performance on the Montreal Cognitive Assessment (MoCA) in patients with stroke or transient ischemic attack. METHODS: MoCA norms were collected from 794 functionally independent and stroke- and dementia-freepersons aged ≥65 years. magnetic resonance imaging was used to exclude healthy controls with significant brain pathology and medial temporal lobe atrophy. Cutoff scores at 16th, 7th, and 2nd percentiles by age and education were derived for the MoCA and MoCA 5-minute Protocol. MoCA performance in 919 patients with stroke or transient ischemic attack was classified using the single and norm-derived cutoff scores. RESULTS: The norms for the Hong Kong version of the MoCA total and domain scores and the total score of the MoCA 5-minute protocol are described. Only 65.1% and 25.7% healthy controls and 45.2% and 19.0% patients scored above the conventional cutoff scores of 21/22 and 25/26 on the MoCA. Using classification with norm-derived cutoff scores as reference, locally derived cutoff score of 21/22 yielded a classification discrepancy of ≤42.4%. Discrepancy increased with higher age and lower education level, with the majority being false positives by single cutoffs. With the 25/26 cutoff of the original MoCA, discrepancy further increased to ≤74.3%. CONCLUSIONS: Conventional single cutoff scores are associated with substantially high rates of misclassification especially in older and less-educated patients with stroke. These results caution against the use of one-size-fits-all cutoffs on the MoCA.
Authors: Ellen Grober; Wenzhu Bi Mowrey; Amy R Ehrlich; Peter Mabie; Steven Hahn; Richard B Lipton Journal: J Clin Exp Neuropsychol Date: 2016-06-07 Impact factor: 2.475
Authors: Janita Pak Chun Chau; Suzanne Hoi Shan Lo; Alexander Yuk Lun Lau; Vivian Wing Yan Lee; Kai Chow Choi; Eddie Chi Fai Kwok; David R Thompson Journal: BMJ Open Date: 2022-07-05 Impact factor: 3.006
Authors: Angus P Yu; Edwin C Chin; Danny J Yu; Daniel Y Fong; Calvin P Cheng; Xiaoqing Hu; Gao X Wei; Parco M Siu Journal: Sci Rep Date: 2022-05-25 Impact factor: 4.996
Authors: Qianyun Chen; Jill Abrigo; Wanting Liu; Elyia Yixun Han; David Ka Wai Yeung; Lin Shi; Lisa Wing Chi Au; Min Deng; Sirong Chen; Eric Yim Lung Leung; Chi Lai Ho; Vincent Chung Tong Mok; Winnie Chiu Wing Chu Journal: Brain Sci Date: 2022-05-31
Authors: Joseph R Geraghty; Melissa N Lara-Angulo; Milen Spegar; Jenna Reeh; Fernando D Testai Journal: J Stroke Cerebrovasc Dis Date: 2020-06-20 Impact factor: 2.136