Optimal Cutoff Scores for Dementia and Mild Cognitive Impairment of the Montreal Cognitive Assessment among Elderly and Oldest-Old Chinese Population

Article type: Research Article

Authors: Tan, Ji-ping^{a; 1} | Li, Nan^{b; 1} | Gao, Jing^{c; *} | Wang, Lu-ning^{a; *} | Zhao, Yi-ming^b | Yu, Bao-cheng^d | Du, Wei^e | Zhang, Wen-jun^f | Cui, Lian-qi^g | Wang, Qing-song^h | Li, Jian-junⁱ | Yang, Jin-sheng^j | Yu, Jian-min^k | Xia, Xiang-nan^l | Zhou, Pei-yi^m

Affiliations: [a] Department of Geriatric Neurology, Chinese PLA General Hospital, Beijing, P.R. China | [b] Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, P.R. China | [c] Department of Neurology, Peking Union Medical College Hospital, Beijing, P.R. China | [d] Department of Gerontology, Bethune International Peace Hospital, Shijiazhuang, P.R. China | [e] Department of Neurology, Chinese PLA 201 Hospital, Dalian, P.R. China | [f] Department of Gerontology, Changhai Hospital, Shanghai, P.R. China | [g] Department of Neurology, Chinese PLA 401 Hospital, Qingdao, P.R. China | [h] Department of Neurology, General Hospital of Chengdu Military Command, Chengdu, P.R. China | [i] Department of Neurology, Chinese PLA 323 Hospital, Xi'an, P.R. China | [j] Department of Neurology, General Hospital of Lanzhou Military Command, Lanzhou, P.R. China | [k] Department of Neurology, Chinese PLA 107 Hospital, Yantai, P.R. China | [l] First Cadre Department, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, P.R. China | [m] Forth Cadre Department, General Hospital of Guangzhou Military Command, Guangzhou, P.R. China

Correspondence: [*] Correspondence to: Jing Gao, Department of Neurology, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, P.R. China. Tel.: +86 10 69156371; Fax: +86 10 69156371; E-mail: gj107@163.com; Lu-ning Wang, Department of Geriatric Neurology, Chinese PLA General Hospital, 28 Fuxing road, Haidian District, Beijing 100853, P.R. China. Tel.: +86 10 66876268; Fax: +86 10 68229325; E-mail: lnw_301@163.com.

Note: [1] These authors contributed equally to this manuscript.

Abstract: Background:All versions of the Montreal Cognitive Assessment (MoCA) lack population-based data of 80-plus individuals. The norms and cut-off scores for mild cognitive impairment (MCI) and dementia of the MoCA are different among five Chinese versions. Objective:To provide the cut-off scores in detecting MCI and dementia of the Peking Medical Union College Hospital version of the MoCA (MoCA-P). Methods:In a cross-sectional survey, Chinese veterans aged ≥60 years completed the MoCA-P and the Mini-Mental State Examination (MMSE). Results:Among 7,445 elderly veterans, 5,085 (68.30%) were aged ≥80 years old, 2,621 (35.20%) had 6 years of education or less, 6,847 (91.97%) were male, and 2,311 (31.04%) and 984 (13.22%) veterans were diagnosed as having MCI and dementia, respectively. Adding two points and one point to the MoCA scores for the primary and middle school groups, respectively, can fully adjust for the notable impact of education but cannot compensate for the effect of age. In the three age groups (60–79, 80–89, and ≥90 years old), the optimal MoCA-P cut-off scores for detecting MCI were ≤25, ≤24, and ≤23, respectively, and for detecting dementia were ≤24, ≤21, and ≤19, respectively, which demonstrated relatively high sensitivities and specificities. The areas under the curves for the MoCA-P for detecting MCI and dementia (0.937 and 0.908, respectively) were greater than those for the MMSE (0.848 and 0.892, respectively). Conclusion:Compared with the MMSE, the MoCA-P is significantly better for detecting MCI in the elderly, particularly in the oldest old population, and it also displays more effectiveness in detecting dementia.

Keywords: Dementia, elderly, mild cognitive impairment, Mini-Mental State Examination, Montreal Cognitive Assessment, oldest old

DOI: 10.3233/JAD-141278

Journal: Journal of Alzheimer's Disease, vol. 43, no. 4, pp. 1403-1412, 2015