Īmong minority populations, educational attainment is a particularly important risk factor for dementia individuals with fewer years of formal education have a greater risk for developing dementia,. This is a timely topic because the number of racial/ethnic minority group members has increased and will continue to increase in the United States. Measurement bias in the Montreal Cognitive Assessment (MoCA) and other screening tools might inflate rates among minorities. Racial/ethnic minorities are disproportionately at risk for dementia African Americans and Hispanics are more likely to develop AD and other dementias than their non-Hispanic White counterparts, likely because of differences in underlying risk factors,. By diagnosing MCI, health care professionals can act to control cardiovascular risk factors, increase exercise, and initiate cognitive training interventions that may reduce progression from MCI to AD. MCI can be used for early detection and prevention of progression to dementia. Mild cognitive impairment (MCI), the stage between healthy cognitive aging and dementia, is defined as greater cognitive impairment than is expected for one's age. Risk factors for AD include nonmodifiable factors, such as older age, family history, and the presence of the apolipoprotein E ( APOE)-ε4 gene, and potentially modifiable risk factors, including low educational attainment, low socioeconomic status, hypertension, smoking, diabetes, depression, and low social and cognitive engagement. However, as this effect may be cohort specific, age and education corrected norms and cut-offs should be developed to help guide MoCA interpretation.Alzheimer's disease (AD), the most common form of dementia, affected approximately 5.5 million Americans in 2017 this number is projected to increase to as high as 16 million by 2050. Clinical judgment about premorbid status should guide interpretation.
Clinically, this loss in sensitivity can lead to an increased number of false negatives, as education level does not always correlate to premorbid intellectual function. The cut-off score yielding the best balance between sensitivity and specificity for the education adjusted MoCA score fell to 25 (61% and 97%, respectively).Īdjusting the MoCA total score for education had a detrimental effect on sensitivity with only a slight increase in specificity. When applying the education correction, sensitivity decreased from 80% to 69% for a small specificity increase (89% to 92%). Thirty-seven healthy controls also completed the MoCA and psychiatric, medical, neurological, functional, and cognitive difficulties were ruled out.įor the total MoCA score, unadjusted for education, a cut-off score of 26 yielded the best balance between sensitivity and specificity (80% and 89% respectively) in identifying cognitive impairment (people with either dementia or aMCI, versus controls). Twenty-five outpatients with dementia and 39 with amnestic mild cognitive impairment (aMCI) underwent a diagnostic evaluation, which included the MoCA. The goal of this study was to quantify the impact of the suggested education correction on the sensitivity and specificity of the Montreal Cognitive Assessment (MoCA).
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