title: Correcting the MoCA for education: effect on sensitivity.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Twenty-five outpatients with dementia and 39 with amnestic mild cognitive impairment (aMCI) underwent a diagnostic evaluation, which included the MoCA. Thirty-seven healthy controls also completed the MoCA and psychiatric, medical, neurological, functional, and cognitive difficulties were ruled out.
  
  
  RESULTS
  For 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). When applying the education correction, sensitivity decreased from 80% to 69% for a small specificity increase (89% to 92%). 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).
  
  
  CONCLUSIONS
  Adjusting the MoCA total score for education had a detrimental effect on sensitivity with only a slight increase in specificity. 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. Clinical judgment about premorbid status should guide interpretation. However, as this effect may be cohort specific, age and education corrected norms and cut-offs should be developed to help guide MoCA interpretation.
authors: Centre for Addiction and Mental Health, University of Toronto, Toronto Department of Psychiatry, University of Toronto, Toronto.
authors: Genevieve
authors: G
authors: Gagnon
authors: Kevin T
authors: KT
authors: Hansen
authors: Sarah
authors: S
authors: Woolmore-Goodwin
authors: Iris
authors: I
authors: Gutmanis
authors: Jennie
authors: J
authors: Wells
authors: Michael
authors: M
authors: Borrie
authors: Jennifer
authors: J
authors: Fogarty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000523:psychology*; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology*; D003877:Dermatitis, Contact; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D012372:ROC Curve; D012189:Retrospective Studies