Original Study| Volume 24, ISSUE 3, P314-320.e2, March 2023

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Examining the Validity and Utility of Montreal Cognitive Assessment Domain Scores for Early Neurocognitive Disorders

Published:February 06, 2023DOI:



      Montreal Cognitive Assessment (MoCA) total scores have been widely used to identify individuals with neurocognitive disorders (NCDs), but the utility of its domain-specific scores have yet to be thoroughly interrogated. This study aimed to validate MoCA's 6 domain-specific scores (ie, Memory, Language, Attention, Executive, Visuospatial, and Orientation) with conventional neuropsychological tests and explore whether MoCA domain scores could discriminate between different etiologies in early NCDs.


      Baseline data of a cohort study.

      Setting and Participants

      Study included 14,571 participants recruited from Alzheimer's Disease Centers across United States, aged ≥50 years, with global Clinical Dementia Rating of ≤1, and mean age of 71.8 ± 8.9 years.


      Participants completed MoCA, conventional neuropsychological tests, and underwent standardized assessments to diagnose various etiologies of NCDs. Partial correlation coefficient was used to examine construct validity between Z scores of neuropsychological tests and MoCA domain scores, whereas multinomial logistic regression examined utility of domain scores to differentiate between etiologies of early NCDs.


      MoCA domain scores correlated stronger with equivalent constructs (r = 0.15-0.43, P < .001), and showed divergence from dissimilar constructs on neuropsychological tests. Participants with Alzheimer's disease were associated with greater impairment in Memory, Attention, Visuospatial, and Orientation domains (RRR = 1.13-1.55, P < .001). Participants with Lewy body disease were impaired in Attention and Visuospatial domains (RRR = 1.21-1.47, P < .001); participants with frontotemporal lobar degeneration were impaired in Language, Executive, and Orientation domains (RRR = 1.25-1.75, P < .01); and participants with Vascular disease were impaired in Attention domain (RRR = 1.14, P < .001).

      Conclusions and Implications

      MoCA domain scores approximate well-established neuropsychological tests and can be valuable in discriminating different etiologies of early NCDs. Although MoCA domain scores may not fully substitute neuropsychological tests, especially in the context of diagnostic uncertainties, they can complement MoCA total scores as part of systematic evaluation of early NCDs and conserve the use of neuropsychological tests to patients who are more likely to require further assessments.


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        • Ganguli M.
        • Blacker D.
        • Blazer D.G.
        • et al.
        Classification of neurocognitive disorders in DSM-5: a work in progress.
        Am J Geriatr. 2011; 19: 205-210
        • Kramarow E.A.
        • Tejada-Vera B.
        Dementia mortality in the United States, 2000-2017.
        Natl Vital Stat. 2019; 68: 1-29
        • El-Hayek Y.H.
        • Wiley R.E.
        • Khoury C.P.
        • et al.
        Tip of the iceberg: assessing the global socioeconomic costs of Alzheimer's disease and related dementias and strategic implications for stakeholders.
        J Alzheimers Dis. 2019; 70: 323-341
        • Nasreddine Z.S.
        • Phillips N.A.
        • Bedirian V.
        • et al.
        The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699
        • Liew T.M.
        • Feng L.
        • Gao Q.
        • Ng T.P.
        • Yap P.
        Diagnostic utility of montreal cognitive assessment in the fifth edition of diagnostic and statistical manual of mental disorders: major and mild neurocognitive disorders.
        J Am Med Dir Assoc. 2015; 16: 144-148
        • Dong Y.
        • Sharma V.K.
        • Chan B.P.
        • et al.
        The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke.
        J Neurol Sci. 2010; 299: 15-18
        • Tsoi K.K.
        • Chan J.Y.
        • Hirai H.W.
        • Wong S.Y.
        • Kwok T.C.
        Cognitive tests to detect dementia: a systematic review and meta-analysis.
        JAMA Intern Med. 2015; 175: 1450-1458
        • Julayanont P.
        • Brousseau M.
        • Chertkow H.
        • Phillips N.
        • Nasreddine Z.S.
        Montreal Cognitive Assessment Memory Index Score (MoCA-MIS) as a predictor of conversion from mild cognitive impairment to Alzheimer's disease.
        J Am Geriatr Soc. 2014; 62: 679-684
        • Kaur A.
        • Edland S.D.
        • Peavy G.M.
        The MoCA-Memory Index Score: an Efficient alternative to paragraph recall for the detection of amnestic mild cognitive impairment.
        Alzheimer Dis Assoc Disord. 2018; 32: 120-124
        • Goldstein F.C.
        • Milloy A.
        • Loring D.W.
        Incremental validity of montreal cognitive assessment index scores in mild cognitive impairment and Alzheimer disease.
        Dement Geriatr Cogn Disord. 2018; 45: 49-55
        • Wood J.L.
        • Weintraub S.
        • Coventry C.
        • et al.
        Montreal Cognitive Assessment (MoCA) performance and domain-specific index scores in amnestic versus aphasic dementia.
        J Int Neuropsychol. 2020; 26: 927-931
        • Kim H.
        • Yu K.H.
        • Lee B.C.
        • Kim B.C.
        • Kang Y.
        Validity of the Montreal Cognitive Assessment (MoCA) index scores: a comparison with the cognitive domain scores of the Seoul Neuropsychological Screening Battery (SNSB).
        Dement Neurocogn Disord. 2021; 20: 28-37
        • Craft S.
        • Newcomer J.
        • Kanne S.
        • et al.
        Memory improvement following induced hyperinsulinemia in Alzheimer's disease.
        Neurobiol Aging. 1996; 17: 123-130
        • Possin K.L.
        • Laluz V.R.
        • Alcantar O.Z.
        • Miller B.L.
        • Kramer J.H.
        Distinct neuroanatomical substrates and cognitive mechanisms of figure copy performance in Alzheimer's disease and behavioral variant frontotemporal dementia.
        Neuropsychologia. 2011; 49: 43-48
        • Ivanova I.
        • Salmon D.P.
        • Gollan T.H.
        The multilingual naming test in Alzheimer's disease: clues to the origin of naming impairments.
        J Int Neuropsychol Soc. 2013; 19: 272-283
        • Lezak M.
        • Howieson D.
        • Bigler E.
        • Tranel D.
        Neuropsychological Assessment.
        Oxford University Press, 2012
        • Wechsler D.
        WMS-R: Wechsler Memory Scale--Revised : Manual.
        Psychological Corporation, 1987
        • Reitan R.M.
        Validity of the trail making test as an indicator of organic brain damage.
        Percept Mot Skills. 1958; 8: 271-276
        • Weintraub S.
        • Besser L.
        • Dodge H.H.
        • et al.
        Version 3 of the Alzheimer disease centers' neuropsychological test battery in the Uniform Data Set (UDS).
        Alzheimer Dis Assoc Disord. 2018; 32: 10-17
        • Morris J.C.
        The Clinical Dementia Rating (CDR): current version and scoring rules.
        Neurology. 1993; 43: 2412-2414
        • Rikkert M.G.
        • Tona K.D.
        • Janssen L.
        • et al.
        Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review.
        Am J Alzheimers Dis Other Demen. 2011; 26: 357-365
        • Petersen R.C.
        • Morris J.C.
        Mild cognitive impairment as a clinical entity and treatment target.
        Arch Neurol. 2005; 62 (discussion 1167): 1160-1163
        • McKhann G.M.
        • Knopman D.S.
        • Chertkow H.
        • et al.
        The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease.
        Alzheimers Dement. 2011; 7: 263-269
        • Albert M.S.
        • DeKosky S.T.
        • Dickson D.
        • et al.
        The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease.
        Alzheimers Dement. 2011; 7: 270-279
        • McKeith I.G.
        • Boeve B.F.
        • Dickson D.W.
        • et al.
        Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium.
        Neurology. 2017; 89: 88-100
        • Litvan I.
        • Bhatia K.P.
        • Burn D.J.
        • et al.
        Movement Disorders Society Scientific Issues Committee report: SIC Task Force appraisal of clinical diagnostic criteria for Parkinsonian disorders.
        Mov Disord. 2003; 18: 467-486
        • McKeith I.G.
        • Dickson D.W.
        • Lowe J.
        • et al.
        Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium.
        Neurology. 2005; 65: 1863-1872
        • Rascovsky K.
        • Hodges J.R.
        • Knopman D.
        • et al.
        Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia.
        Brain. 2011; 134: 2456-2477
        • Bensimon G.
        • Ludolph A.
        • Agid Y.
        • Vidailhet M.
        • Payan C.
        • Leigh P.N.
        Riluzole treatment, survival and diagnostic criteria in Parkinson plus disorders: the NNIPPS study.
        Brain. 2009; 132: 156-171
        • Armstrong M.J.
        • Litvan I.
        • Lang A.E.
        • et al.
        Criteria for the diagnosis of corticobasal degeneration.
        Neurology. 2013; 80: 496-503
        • Brooks B.R.
        • Miller R.G.
        • Swash M.
        • Munsat T.L.
        El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis.
        Amyotroph Lateral Scler Other Motor Neuron Disord. 2000; 1: 293-299
        • Neary D.
        • Snowden J.S.
        • Gustafson L.
        • et al.
        Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria.
        Neurology. 1998; 51: 1546-1554
        • Litvan I.
        • Agid Y.
        • Calne D.
        • et al.
        Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop.
        Neurology. 1996; 47: 1-9
        • Manolio T.A.
        • Kronmal R.A.
        • Burke G.L.
        • et al.
        Magnetic resonance abnormalities and cardiovascular disease in older adults. The Cardiovascular Health Study.
        Stroke. 1994; 25: 318-327