Department of Supportive Care Medicine, City of Hope Medical Center, Duarte, CA.
Department of Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA.
Alzheimer Dis Assoc Disord. 2018 Jul-Sep;32(3):207-213. doi: 10.1097/WAD.0000000000000241.
The Montreal Cognitive Assessment (MoCA) has not been administered to a representative national sample, precluding comparison of patient scores to the general population and for risk factor identification.
A validated survey-based adaptation of the MoCA (MoCA-SA) was administered to a probability sample of home-dwelling US adults aged 62 to 90, using the National Social Life, Health, and Aging Project (n=3129), yielding estimates of prevalence in the United States. The association between MoCA-SA scores and sociodemographic and health-related risk factors were determined.
MoCA-SA scores decreased with age, and there were substantial differences among sex, education, and race/ethnicity groups. Poor physical health, functional status, and depression were also associated with lower cognitive performance; current health behaviors were not. Using the recommended MoCA cut-point score for Mild Cognitive Impairment (MoCA score <26; MoCA-SA score <17), 72% (95% confidence interval, 69% to 74%) of older US adults would be classified as having some degree of cognitive impairment.
Our results provide an important national estimate for interpreting MoCA scores from individual patients, and establish wide variability in cognition among older home-dwelling US adults. Care should be taken in applying previously-established MoCA cut-points to the general population, especially when evaluating individuals from educationally and ethnically diverse groups.
蒙特利尔认知评估（MoCA）尚未在代表性的全国样本中进行测试，这使得无法将患者的分数与普通人群进行比较，也无法确定风险因素。
使用全国社会生活、健康和老龄化项目（n=3129）对 62 至 90 岁的美国家庭居住成年人进行了一项基于调查的 MoCA（MoCA-SA）的验证性测试，从而得出了美国的患病率估计值。确定了 MoCA-SA 评分与社会人口统计学和与健康相关的风险因素之间的关联。
MoCA-SA 评分随年龄的增长而降低，并且在性别、教育程度和种族/民族群体之间存在很大差异。身体健康状况差、功能状态和抑郁也与认知表现下降有关；而当前的健康行为则没有。使用轻度认知障碍的推荐 MoCA 截断分数（MoCA 得分<26；MoCA-SA 得分<17），72%（95%置信区间，69%至 74%）的美国老年人将被归类为存在某种程度的认知障碍。
我们的研究结果为解释个体患者的 MoCA 分数提供了重要的全国性估计值，并确定了美国老年家庭居住成年人认知能力的广泛差异。在将以前建立的 MoCA 截断值应用于普通人群时，特别是在评估来自不同教育和种族群体的个体时，应谨慎行事。
