![]() 4, 5 A score of less than 22 is considered positive for screening and calls for further diagnostic assessment. In Hong Kong, a local version of MoCA, the Hong Kong version (HK-MoCA), was validated in Chinese older adults. 3 Demographically adjusted norms may help improve the diagnostic accuracy. ![]() Moreover, the one-point correction for education has been debated as insufficient to compensate for educational differences. 2 Some studies have revealed that the originally recommended cutoff score of 26 leads to a higher false positive misclassification especially on those with increasing age and/or low education. Systematic review highlighted the necessity for cross-cultural considerations when using the MoCA as a screening tool. 1 There is a one-point adjustment for individuals with formal education of 12 years or fewer. The Montreal Cognitive Assessment (MoCA) is a brief, useful and validated cognitive screening instrument with a cutoff score of 26 to differentiate mild cognitive impairment (MCI) or dementia from normal. A cognitive screening measure with high sensitivity and specificity is essential for them to decide who needs a more detailed evaluation or make a referral for comprehensive geriatric assessments, including neuropsychological evaluations. Individuals concerned about their memory loss are mostly seen by primary care physicians. Poor memory is one of the commonest presenting complaints and other features include disturbances of behaviour, language, mood, personality or perception. Keywords: dementia, Hong Kong, mild cognitive impairment, Montreal Cognitive Assessment, MoCA, screeningĭementia is a major neurodegenerative disorder and often begins with focal cognitive or behavioural disturbances. Single cutoff scores with inherent simple education adjustment achieved screening purpose of mild cognitive impairment and dementia in Chinese older adults. Administration time is relatively short, and it has incorporated essential cognitive domains. The consistency decreased with older age and lower education level, and majority of misclassifications were false negatives.Ĭonclusion: HK-MoCA is a convenient screening tool to detect cognitive impairment. The accuracy of correctly classifying tested subjects into appropriate groups was 85.3% if single cutoff was used though the consistency between norm-derived cutoffs and expert diagnoses were only 59.0%, 54.2%, and 53.9% at 16th, 7th, and 2nd percentiles, respectively. However, age and education adjusted cutoff scores achieved high specificities at all levels of cognitive impairment with trade-off of sensitivities. In identifying cognitive impairment, the sensitivity and specificity were 0.932 and 0.723, respectively. ![]() To detect dementia, its sensitivity was 0.922, and specificity was 0.923. Results: Single cutoff score of HK-MoCA differentiated MCI from normal with sensitivity of 0.861 and specificity of 0.723. ![]() Comparison was made with the single cutoff scores validated in a local study with 21/22 for MCI and 18/19 for dementia. Norm-derived age and education adjusted cutoff scores were at 16th, 7th, and 2nd percentiles. ![]() The HK-MoCA total scores were evaluated using different cutoffs. Methods: Total scores of HK-MoCA were collected from 315 subjects (128 with dementia, 122 with mild cognitive impairment (MCI) and 65 normal) attending a public district hospital-based cognition clinic from 2012 to 2017. Pui Yu Yeung, 1 LL Louise Wong, 2 Chun Chung Chan, 2 Cho Yiu Yung, 3 LM Jess Leung, 2 Yuen Yee Tam, 3 Lap Nin Tang, 3 Hiu Sze Li, 3 Mei Ling Lau 3ġDepartment of Medicine, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong Special Administrative Region, People’s Republic of China 2Private Practice, Tsim Sha Tsui and Central, Hong Kong Special Administrative Region, People’s Republic of China 3Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong Special Administrative Region, People’s Republic of Chinaĭepartment of Medicine, Tung Wah Eastern Hospital, 19 Eastern Hospital Road, Causeway Bay, Hong Kong Special Administrative Region, People’s Republic of Chinaīackground and Purpose: The study evaluated the performance between norm-derived age and education adjusted vs single cutoff scores of the Montreal Cognitive Assessment, Hong Kong version (HK-MoCA) in classifying cognitive impairment in Chinese older adults. ![]()
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