Skip to main content

Advertisement

SpringerLink
Log in

Italians do it worse. Montreal Cognitive Assessment (MoCA) optimal cut-off scores for people with probable Alzheimer’s disease and with probable cognitive impairment

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Montreal cognitive assessment (MoCA) is a test providing a brief screening for people with cognitive impairment due to aging or neurodegenerative syndromes. In Italy, as in the rest of the world, several validation studies of MoCA have been carried out. This study compared, for the first time in Italy, a sample of people with probable Alzheimer’s Disease (AD) with healthy counterparts. The study also compared two community-dwelling groups of aged participants with and without probable cognitive impairment, as discriminated by two cut-off points of adjusted MMSE score. All the comparisons were carried out according to ROC statistics. Optimal cutoff for a diagnosis of probable AD was a MoCA score ≤14. Optimal cutoff for the discrimination of probable cognitive impairment was a MoCA score ≤17 (associated to MMSE cutoff of 23.8). Results confirm the substantial discrepancy in cut-off points existing between Italian and other international validation studies, showing that Italian performance on MoCA seems to be globally lower than that in other Countries. Characteristics of population might explain these results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Nasreddine ZS, Phillips NA, Bédirian V et al (2005) The Montreal Cognitive Assessment MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699

    Article  PubMed  Google Scholar 

  2. Gil L, Ruiz de Sánchez C, Gil F et al (2015) Validation of the Montreal Cognitive Assessment (MoCA) in Spanish as a screening tool for mild cognitive impairment and mild dementia in patients over 65 years old in Bogotá Colombia. Int J Geriatr Psychiatry 30:655–662

    Article  PubMed  Google Scholar 

  3. Ng TP, Feng L, Lim WS et al (2015) Montreal Cognitive Assessment for screening mild cognitive impairment: variations in test performance and scores by education in Singapore. Dement Geriatr Cogn Disord 39:176–185

    Article  PubMed  Google Scholar 

  4. Kaya Y, Aki OE, Can UA et al (2014) Validation of Montreal Cognitive Assessment and discriminant power of Montreal Cognitive Assessment subtests in patients with mild cognitive impairment and Alzheimer dementia in Turkish population. J Geriatr Psychiatry Neurol 27:103–109

    Article  PubMed  Google Scholar 

  5. Pirrotta F, Timpano F, Bonanno L et al (2015) Italian validation of montreal cognitive assessment. Eur J Psychol Assess 31:131–137

    Article  Google Scholar 

  6. Fujiwara Y, Suzuki H, Yasunaga M et al (2010) Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment. Geriatr Gerontol Int 10:225–232

    Article  PubMed  Google Scholar 

  7. Freitas S, Simões MR, Alves L et al (2013) Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Dis Assoc Disord 27:37–43

    Article  PubMed  Google Scholar 

  8. Hu JB, Zhou WH, Hu SH et al (2013) Cross-cultural difference and validation of the Chinese version of Montreal Cognitive Assessment in older adults residing in Eastern China: preliminary findings. Arch Gerontol Geriatr 56:38–43

    Article  PubMed  Google Scholar 

  9. Lee JY, Lee DW, Cho SJ et al (2008) Brief screening for mild cognitive impairment in elderly outpatient clinic: validation of the Korean version of the Montreal Cognitive Assessment. J Geriatr Psychiatry Neurol 21:104–110

    Article  PubMed  Google Scholar 

  10. Lifshitz M, Dwolatzky T, Press Y (2012) Validation of the Hebrew version of the MoCA test as a screening instrument for the early detection of mild cognitive impairment in elderly individuals. J Geriatr Psychiatry Neurol 25:155–161

    Article  PubMed  Google Scholar 

  11. Luis CA, Keegan AP, Mullan M (2009) Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry 24:197–201

    Article  PubMed  Google Scholar 

  12. Memória CM, Yassuda MS, Nakano EY et al (2013) Brief screening for mild cognitive impairment: validation of the Brazilian version of the Montreal cognitive assessment. Int J Geriatr Psychiatry 28:34–40

    Article  PubMed  Google Scholar 

  13. Tsai CF, Lee WJ, Wang SJ et al (2012) Psychometrics of the Montreal Cognitive Assessment (MoCA) and its subscales: validation of the Taiwanese version of the MoCA and an item response theory analysis. Int Psychogeriatr 24:651–658

    Article  PubMed  Google Scholar 

  14. Yeung PY, Wong LL, Chan CC et al (2014) A validation study of the Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) in Chinese older adults in Hong Kong. Hong Kong Med J 20:504–510

    CAS  PubMed  Google Scholar 

  15. Yu J, Li J, Huang X (2012) The Beijing version of the montreal cognitive assessment as a brief screening tool for mild cognitive impairment: a community-based study. BMC Psychiatry 12:156

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pirani A, Tulipani C, Neri M (2006) Italian translation of MoCA test and of its instructions. Retrieved from http://www.mocatest.org

  17. Conti S, Bonazzi S, Laiacona M et al (2015) Montreal Cognitive Assessment (MoCA)-Italian version: regression based norms and equivalent scores. Neurol Sci 36:209–214

    Article  PubMed  Google Scholar 

  18. Santangelo G, Siciliano M, Pedone R et al (2015) Normative data for the Montreal Cognitive Assessment in an Italian population sample. Neurol Sci 36:585–591

    Article  PubMed  Google Scholar 

  19. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  20. Harder VS, Stuart EA, Anthony JC (2010) Propensity score techniques and the assessment of measured covariate balance to test causal associations in psychological research. Psychol methods 15:234

    Article  PubMed  PubMed Central  Google Scholar 

  21. Dubois B, Feldman HH, Jacova C et al (2007) Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS–ADRDA criteria. Lancet Neurol 6:734–746

    Article  PubMed  Google Scholar 

  22. Morris JC (1997) Clinical Dementia Rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. Int Psychogeriatr 9:173–176

    Article  PubMed  Google Scholar 

  23. Thombaugh TN, McIntyre NJ (1992) The mini mental state examination: a comprehensive review. J Am Geriatr Soc 40:922–935

    Article  Google Scholar 

  24. Ho DE, Imai K, King G et al (2011) MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw 42:1–28

    Article  Google Scholar 

  25. Ward A, Arrighi HM, Michels S et al (2012) Mild cognitive impairment: disparity of incidence and prevalence estimates. Alzheimers Dement 8:14–21

    Article  PubMed  Google Scholar 

  26. Hayden KM, Makeeva OA, Newby LK et al (2014) A comparison of neuropsychological performance between US and Russia: preparing for a global clinical trial. Alzheimers Dement 10:760–768

    Article  PubMed  PubMed Central  Google Scholar 

  27. Caffò AO, Lopez A, Spano G et al (2016) The role of pre-morbid intelligence and cognitive reserve in predicting cognitive efficiency in a sample of italian elderly. Aging Clin Exp Res 28:1203–1210

    Article  PubMed  Google Scholar 

  28. Lynn R (2001) National IQ and economic development: a study of eighty-one nations. Mankind Q 41:415

    Google Scholar 

  29. Lynn R, Vanhanen T (2012) National IQs: a review of their educational cognitive economic political demographic sociological epidemiological geographic and climatic correlates. Intelligence 40:226–234

    Article  Google Scholar 

  30. Del Brutto OH, Mera RM, Del Brutto VJ et al (2016) The bicaudate index inversely associates with performance in the Montreal Cognitive Assessment (MoCA) in older adults living in rural Ecuador. The Atahualpa project. Int J Geriatr Psychiatry doi:10.1002/gps.4419

    PubMed  Google Scholar 

  31. Sayegh P, Knight BG (2013) Cross-cultural differences in dementia: the Sociocultural Health Belief Model. Int Psychogeriatr 25:517–530

    Article  PubMed  Google Scholar 

  32. Caffò AO, De Caro MF, Picucci L et al (2012) Reorientation deficits are associated with amnestic mild cognitive impairment. Am J Alzheimers Dis Other Demen 27:321–330

    Article  PubMed  Google Scholar 

  33. Picucci L, Caffò AO, Bosco A (2009) Age and sex differences in a virtual version of the reorientation task. Cogn Process 10:S272–S275

    Article  PubMed  Google Scholar 

  34. Kelaiditi E, Cesari M, Canevelli M et al (2013) Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. J Nutr Health Aging 17:726–734

    Article  CAS  PubMed  Google Scholar 

  35. Giannini M, Solfrizzi V, Panza F et al (2015) Additive role of a cognitive frailty model and inflammatory state on the risk of disability. The Italian Longitudinal Study on Aging (S36. 009). Neurology 84:S36–S009

    Article  Google Scholar 

  36. Panza F, Seripa D, Solfrizzi V et al (2015) Targeting cognitive frailty: clinical and neurobiological roadmap for a single complex phenotype. J Alzheimers Dis 47:793–813

    Article  PubMed  Google Scholar 

  37. Feng L, Nyunt MSZ, Gao Q et al (2016) Physical frailty, cognitive impairment, and the risk of neurocognitive disorder in the Singapore Longitudinal Ageing Studies. J Gerontol A Biol Sci Med Sci. doi:10.1093/gerona/glw050

    PubMed  Google Scholar 

  38. Ruan Q, Yu Z, Chen M et al (2015) Cognitive frailty, a novel target for the prevention of elderly dependency. Ageing Res Rev 20:1–10

    Article  PubMed  Google Scholar 

  39. Montero-Odasso MM, Barnes B, Speechley M et al (2016) Disentangling cognitive-frailty: results from the gait and brain study. J Gerontol A Biol Sci Med Sci 71:1476–1482

    Article  PubMed  Google Scholar 

  40. Solfrizzi V, Scafato E, Seripa D et al (2017) Reversible cognitive frailty, dementia, and all-cause mortality. The Italian Longitudinal Study on Aging. J Am Med Dir Assoc 18(89):e1-89.e8

    Google Scholar 

  41. Arsenault-Lapierre G, Whitehead V, Belleville S et al (2011) Mild cognitive impairment subcategories depend on the source of norms. J Clin Exp Neuropsychol 33:596–603

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The first author was supported by the project “An automatic system of verbal instructions to promote activities of daily living in patients with Mild Cognitive Impairment: Intervention effectiveness and manipulation of linguistic parameters” (AB, Fondi Ateneo, Es. Fin. 2014), and the third author by the project “Epidemiology of Topographical Disorientation and Mild Cognitive Impairment in a South Italian elderly population”—Action Co-founded by Cohesion and Development Fund 2007–2013—APQ Research Puglia Region “Regional programme supporting smart specialization and social and environmental sustainability – FutureInResearch”(AOC, Grant Code CEY4SQ4).

Author information

Authors and Affiliations

  1. Department of Educational Sciences, Psychology, Communication, University of Study Bari, Via Crisanzio 42, 70122, Bari, Italy

    Andrea Bosco, Giuseppina Spano, Alessandro O. Caffò, Antonella Lopez, Ignazio Grattagliano & Giuseppe Saracino

  2. Interdisciplinary Department of Medicine, University of Study Bari, Bari, Italy

    Ignazio Grattagliano

  3. Associazione Alzheimer Bari Onlus, Centro Alzheimer “Don Tonino Bello”, Bari, Italy

    Katia Pinto

  4. The Hague University of Applied Sciences, The Hague, The Netherlands

    Frans Hoogeveen

  5. Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Corso Italia 23, Bari, Italy

    Giulio E. Lancioni

Authors
  1. Andrea Bosco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppina Spano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandro O. Caffò
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonella Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ignazio Grattagliano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giuseppe Saracino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Katia Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Frans Hoogeveen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giulio E. Lancioni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Bosco.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study was approved by a local ethical committee and was performed in accordance to the Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bosco, A., Spano, G., Caffò, A.O. et al. Italians do it worse. Montreal Cognitive Assessment (MoCA) optimal cut-off scores for people with probable Alzheimer’s disease and with probable cognitive impairment. Aging Clin Exp Res 29, 1113–1120 (2017). https://doi.org/10.1007/s40520-017-0727-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-017-0727-6

Keywords

Search

Navigation