The Montreal Cognitive Assessment-Basic: A Screening Tool for Mild Cognitive Impairment in Illiterate and Low-Educated Elderly Adults

Abstract

Objectives: To assess the validity of a newly developed cognitive screening tool, the Montreal Cognitive Assessment-Basic (MoCA-B), in screening for mild cognitive impairment (MCI) in elderly adults with low education and varying literacy.

Design: Cross-sectional.

Setting: Community hospital in Bangkok, Thailand.

Participants: Cognitively normal controls (n = 43) and individuals with MCI according to the National Institute on Aging-Alzheimer's Association work group criteria (n = 42) aged 55 to 80 with less than 5 years of education.

Measurements: MoCA-B scores.

Results: Mean MoCA-B scores were 26.3 ± 1.6 for illiterate controls and 21.3 ± 3.8 for illiterate participants with MCI (P < .001) and 26.6 ± 2.0 for literate controls and 23.0 ± 2.1 for literate participants with MCI (P < .001). MoCA-B scores did not differ significantly according to literacy, and multiple regression suggested no association with age or education. The optimal cutoff score of 24 out of 25 yielded 81% sensitivity and 86% specificity for MCI (area under the receiver operating characteristic curve = 0.90, P < .001). Test-retest reliability was 0.91 (P < .001), and internal consistency was 0.82. Administration time was 15 to 21 minutes.

Conclusion: The MoCA-B appears to have excellent validity and addresses an unmet need by accurately screening for MCI in poorly educated older adults regardless of literacy.

Keywords: mild cognitive impairment; Montreal Cognitive Assessment; mild cognitive impairment; screening.