Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
New England GRECC, VA Boston Healthcare System, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2024 Mar;72(3):850-857. doi: 10.1111/jgs.18705. Epub 2024 Jan 10.
Efficacy and validity of the MoCA for cognitive screening in ethnoculturally and linguistically diverse settings is unclear. We sought to examine the utility and discriminative validity of the Spanish and English MoCA versions to identify cognitive impairment among diverse community-dwelling older adults.
Participants aged ≥65 with cognitive concerns attending outpatient primary care in Bronx, NY, were recruited. MoCA and neuropsychological measures were administered in Spanish or English, and a neuropsychologist determined cognitive status (normal with subjective cognitive concerns [SCC], mild cognitive impairment [MCI], and dementia). One-way ANOVA compared cognitive statuses. ROC analyses identified optimal MoCA cutpoints for discriminating possible cognitive impairment.
There were 231 participants, with mean age 73, 72% women, 43% Hispanic; 39% Black/African American; 113 (49%) completed testing in English and 118 (51%) in Spanish. Overall MoCA mean was 17.7 (SD = 4.3). Neuropsychological assessment identified 90 as cognitively normal/SCC, average MoCA 19.9 (SD = 4.1), 133 with MCI, average MoCA 16.6 (SD = 3.7), and 8 with dementia, average MoCA 10.6 (SD = 3.1). Mean English MoCA average was 18.6 (SD = 4.1) versus Spanish 16.7 (SD = 4.3). The published cutpoint ≤23 for MCI yielded a high false-positive rate (79%). ROC analyses identified ≤18.5 as the score to identify MCI or dementia using the English MoCA (65% sensitivity; 77% specificity) and ≤16.5 for the Spanish MoCA (64% sensitivity;73% specificity) in this sample of older adults with cognitive concerns.
Current MoCA cutpoints were inappropriately high in a culturally/linguistically diverse urban setting, leading to a high false-positive rate. Lower Spanish and English MoCA cutpoints may improve diagnostic accuracy for identifying cognitive impairment in this group, highlighting the need for the creation and validation of accurate cognitive screeners for ethnoculturally and linguistically diverse older adults.
MoCA 用于评估文化和语言背景多样化的人群的认知功能的有效性和准确性尚不清楚。本研究旨在评估西班牙语和英语 MoCA 版本在识别不同社区居住的老年人群认知障碍方面的效用和判别效度。
在纽约布朗克斯的初级保健门诊招募有认知问题的 65 岁以上老年人。受试者接受 MoCA 和神经心理学测试，测试结果由神经心理学家判定（认知正常伴有主观认知障碍[SCC]、轻度认知障碍[MCI]和痴呆）。采用单因素方差分析比较不同认知状态。通过 ROC 分析确定 MoCA 最佳截断值，以区分可能的认知障碍。
共有 231 名参与者，平均年龄为 73 岁，72%为女性，43%为西班牙裔；39%为非裔美国人；113 名（49%）以英语完成测试，118 名（51%）以西班牙语完成测试。总体 MoCA 平均得分为 17.7（SD=4.3）。神经心理学评估结果显示，90 名认知正常/SCC，MoCA 平均得分为 19.9（SD=4.1），133 名 MCI，MoCA 平均得分为 16.6（SD=3.7），8 名痴呆，MoCA 平均得分为 10.6（SD=3.1）。英语 MoCA 的平均得分为 18.6（SD=4.1），西班牙语 MoCA 的平均得分为 16.7（SD=4.3）。目前用于 MCI 的 MoCA 截断值（≤23）假阳性率很高（79%）。ROC 分析表明，在该有认知问题的老年人群中，使用英语 MoCA 时，≤18.5 为 MCI 或痴呆的得分（65%的敏感性；77%的特异性），而使用西班牙语 MoCA 时，≤16.5 为 MCI 或痴呆的得分（64%的敏感性；73%的特异性）。
在文化和语言多样化的城市环境中，目前的 MoCA 截断值过高，导致假阳性率较高。较低的西班牙语和英语 MoCA 截断值可能会提高该人群认知障碍的诊断准确性，这凸显了为文化和语言多样化的老年人创建和验证准确认知筛查工具的必要性。
