title: A validation study of the Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) in Chinese older adults in Hong Kong.
abstract: OBJECTIVE
  To validate the Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) in identification of mild cognitive impairment and dementia in Chinese older adults.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Cognition clinic and memory clinic of a public hospital in Hong Kong.
  
  
  METHODS
  A total of 272 participants (dementia, n=130; mild cognitive impairment, n=93; normal controls, n=49) aged 60 years or above were assessed using HK-MoCA. The HK-MoCA scores were validated against expert diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed) criteria for dementia and Petersen's criteria for mild cognitive impairment. Statistical analysis was performed using receiver operating characteristic curve and regression analyses. Additionally, comparison was made with the Cantonese version of Mini-Mental State Examination and Global Deterioration Scale.
  
  
  RESULTS
  The optimal cutoff score for the HK-MoCA to differentiate cognitive impaired persons (mild cognitive impairment and dementia) from normal controls was 21/22 after adjustment of education level, giving a sensitivity of 0.928, specificity of 0.735, and area under the curve of 0.920. Moreover, the cutoff to detect mild cognitive impairment was 21/22 with a sensitivity of 0.828, specificity of 0.735, and area under the curve of 0.847. Score of the Cantonese version of the Mini-Mental State Examination to detect mild cognitive impairment was 26/27 with a sensitivity of 0.785, specificity of 0.816, and area under the curve of 0.857. At the optimal cutoff of 18/19, HK-MoCA identified dementia from controls with a sensitivity of 0.923, specificity of 0.918, and area under the curve of 0.971.
  
  
  CONCLUSIONS
  The HK-MoCA is a useful cognitive screening instrument for use in Chinese older adults in Hong Kong. A score of less than 22 should prompt further diagnostic assessment. It has comparable sensitivity with the Cantonese version of Mini-Mental State Examination for detection of mild cognitive impairment. It is brief and feasible to conduct in the clinical setting, and can be completed in less than 15 minutes. Thus, HK-MoCA provides an attractive alternative screening instrument to Mini-Mental State Examination which has ceiling effect (ie may fail to detect mild/moderate cognitive impairment in people with high education level or premorbid intelligence) and needs to be purchased due to copyright issues.
authors.affiliation: Department of Rehabilitation, Kowloon Hospital, 147A Argyle Street, Hong Kong.
authors.forename: P Y
authors.initials: PY
authors.lastname: Yeung
authors.affiliation: Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong.
authors.forename: L L
authors.initials: LL
authors.lastname: Wong
authors.affiliation: Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
authors.forename: C C
authors.initials: CC
authors.lastname: Chan
authors.affiliation: Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong.
authors.forename: Jess L M
authors.initials: JL
authors.lastname: Leung
authors.affiliation: Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
authors.forename: C Y
authors.initials: CY
authors.lastname: Yung
mesh_terms: D000368:Aged; D044466:Asian People; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged; D006723:Hong Kong; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D015203:Reproducibility of Results
keywords: Cognition disorders; Hong Kong; Sensitivity and specificity