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Psychometrics of the Montreal Cognitive Assessment (MoCA) and its subscales: validation of the Taiwanese version of the MoCA and an item response theory analysis

Published online by Cambridge University Press:  12 December 2011

Chia-Fen Tsai ,
Wei-Ju Lee ,
Shuu-Jiun Wang ,
Ben-Chang Shia ,
Ziad Nasreddine  and
Jong-Ling Fuh
Chia-Fen Tsai
Affiliation:
Department of Psychiatry, Neurological Institute, Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University Schools of Medicine, Taipei, Taiwan Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
Wei-Ju Lee
Affiliation:
Institute of Clinical Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
Shuu-Jiun Wang
Affiliation:
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
Ben-Chang Shia
Affiliation:
Department of Statistics and Information Science, Fu-Jen Catholic University, Taipei, Taiwan
Ziad Nasreddine
Affiliation:
Center for Clinical Research, Neurology Service, University of Sherbrooke, Hôpital Charles LeMoyne, Sherbrooke, Quebec, Canada
Jong-Ling Fuh*
Affiliation:
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
*
Correspondence should be addressed to: Dr. Jong-Ling Fuh, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, 112. Phone: +886-2-28762522; Fax: +886-2-28765215. Email: jlfuh@vghtpe.gov.tw.
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Abstract

Background: The Montreal Cognitive Assessment (MoCA) is an instrument for screening mild cognitive impairment (MCI). This study examined the psychometric properties and the validity of the Taiwan version of the MoCA (MoCA-T) in an elderly outpatient population.

Methods: Participants completed the MoCA-T, Mini-Mental State Examination (MMSE), and the Chinese Version Verbal Learning Test. The diagnosis of Alzheimer's disease (AD) was made based on the NINCDS-ADRDA criteria, and MCI was diagnosed through the criteria proposed by Petersen et al. (2001).

Results: Data were collected from 207 participants (115 males/92 females, mean age: 77.3 ± 7.5 years). Ninety-eight participants were diagnosed with AD, 71 with MCI, and 38 were normal controls. The area under the receiver operator curves (AUC) for predicting AD was 0.98 (95% confidence interval [CI] = 0.97–1.00) for the MMSE, and 0.99 (95% CI = 0.98–1.00) for the MoCA-T. The AUC for predicting MCI was 0.81 (95% CI = 0.72–0.89) using the MMSE and 0.91 (95% CI = 0.86–1.00) using the MoCA-T. Using an optimal cut-off score of 23/24, the MoCA-T had a sensitivity of 92% and specificity of 78% for MCI. Item response theory analysis indicated that the level of information provided by each subtest of the MoCA-T was consistent. The frontal and language subscales provided higher discriminating power than the other subscales in the detection of MCI.

Conclusion: Compared to the MMSE, the MoCA-T provides better psychometric properties in the detection of MCI. The utility of the MoCA-T is optimal in mild to moderate cognitive dysfunction.

Keywords

The Montreal Cognitive AssessmentAlzheimer's diseasemild cognitive impairmentvalidationitem response theory
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 4 , April 2012 , pp. 651 - 658
Copyright
Copyright © International Psychogeriatric Association 2011

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