Department of Clinical Psychology, Mercer University College of Health Professions, Atlanta, GA, USA.
Cognitive Rehabilitation of Georgia, Atlanta, GA, USA.
Clin Neuropsychol. 2023 Apr;37(3):562-576. doi: 10.1080/13854046.2022.2086487. Epub 2022 Jun 14.
The Montreal Cognitive Assessment (MoCA) is a common cognitive screener for detecting mild cognitive impairment (MCI). However, previously suggested cutoff scores of 26/30 and above is often criticized and lacks racial diversity. The purpose of this study is to investigate the potential influence of race on MoCA classification cutoff score accuracy.
Data were obtained from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set and yielded 4,758 total participants. Participants were predominately White (82.8%) and female (61.7%) with a mean age of 69.3 years () and education level of 16.3 years (. Based on NACC's classification, participants were either cognitively normal ( = 3,650) or MCI ( = 1,108).
Sensitivity and specificity analyses revealed that when using the cutoff score of ≤26/30, the MoCA correctly classified 73.2% of White cognitively normal participants and 83.1% of White MCI participants. In contrast, this criterion correctly classified 40.5% of Black cognitively normal participants and 90.8% of Black MCI participants. Our sample was highly educated; therefore, we did not observe significant differences in scores when accounting for education across race. Classification statistics are presented.
Black participants were misclassified at a higher rate than White participants when applying the ≤26/30 cutoff score. We suggest cutoff scores of ≤25/30 be applied to White persons and ≤22/30 for Black persons. These findings highlight the need for racially stratified population-based norms given the high misclassification of Black participants without such adjustment.
蒙特利尔认知评估（MoCA）是一种常用的认知筛查工具，用于检测轻度认知障碍（MCI）。然而，之前建议的 26/30 及以上的分界值常受到批评，且缺乏种族多样性。本研究旨在探讨种族对 MoCA 分类分界值准确性的潜在影响。
数据来自国家阿尔茨海默病协调中心（NACC）的统一数据集，共纳入 4758 名参与者。参与者主要为白人（82.8%）和女性（61.7%），平均年龄为 69.3 岁（），教育水平为 16.3 年（）。根据 NACC 的分类，参与者为认知正常（ = 3650）或 MCI（ = 1108）。
敏感性和特异性分析显示，当使用分界值≤26/30 时，MoCA 正确分类了 73.2%的白人认知正常参与者和 83.1%的白人 MCI 参与者。相比之下，这一标准正确分类了 40.5%的黑人认知正常参与者和 90.8%的黑人 MCI 参与者。我们的样本受教育程度较高；因此，我们没有观察到按种族分类时，教育程度对分数的显著影响。我们呈现了分类统计数据。
当应用≤26/30 的分界值时，黑人参与者的分类错误率高于白人参与者。我们建议，白人的分界值为≤25/30，黑人的分界值为≤22/30。这些发现强调了在没有这种调整的情况下，由于黑人参与者的高分类错误率，需要制定基于种族的分层人群正常值。
