Abstract
Objectives
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.
Design
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.
Methods
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.
Results
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.
Keywords
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Article info
Publication history
Published online: February 06, 2023
Footnotes
Funding sources: This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
The authors declare no conflicts of interest.
Identification
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© 2023 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
