title: Montreal Cognitive Assessment for screening mild cognitive impairment: variations in test performance and scores by education in Singapore.
abstract: BACKGROUND
  The Montreal Cognitive Assessment (MoCA) was developed as a screening instrument for mild cognitive impairment (MCI). We evaluated the MoCA's test performance by educational groups among older Singaporean Chinese adults.
  
  
  METHODS
  The MoCA and Mini-Mental State Examination (MMSE) were evaluated in two independent studies (clinic-based sample and community-based sample) of MCI and normal cognition (NC) controls, using receiver operating characteristic curve analyses: area under the curve (AUC), sensitivity (Sn), and specificity (Sp).
  
  
  RESULTS
  The MoCA modestly discriminated MCI from NC in both study samples (AUC = 0.63 and 0.65): Sn = 0.64 and Sp = 0.36 at a cut-off of 28/29 in the clinic-based sample, and Sn = 0.65 and Sp = 0.55 at a cut-off of 22/23 in the community-based sample. The MoCA's test performance was least satisfactory in the highest (>6 years) education group: AUC = 0.50 (p = 0.98), Sn = 0.54, and Sp = 0.51 at a cut-off of 27/28. Overall, the MoCA's test performance was not better than that of the MMSE. In multivariate analyses controlling for age and gender, MCI diagnosis was associated with a <1-point decrement in MoCA score (η(2) = 0.010), but lower (1-6 years) and no education was associated with a 3- to 5-point decrement (η(2) = 0.115 and η(2) = 0.162, respectively).
  
  
  CONCLUSIONS
  The MoCA's ability to discriminate MCI from NC was modest in this Chinese population, because it was far more sensitive to the effect of education than MCI diagnosis.
authors.affiliation: Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Tze Pin
authors.initials: TP
authors.lastname: Ng
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Wee Shiong
authors.initials: WS
authors.lastname: Lim
authors.forename: Mei Sian
authors.initials: MS
authors.lastname: Chong
authors.forename: Tih Shih
authors.initials: TS
authors.lastname: Lee
authors.forename: Keng Bee
authors.initials: KB
authors.lastname: Yap
authors.forename: Tung
authors.initials: T
authors.lastname: Tsoi
authors.forename: Tau Ming
authors.initials: TM
authors.lastname: Liew
authors.forename: Qi
authors.initials: Q
authors.lastname: Gao
authors.forename: Simon
authors.initials: S
authors.lastname: Collinson
authors.forename: Nagaendran
authors.initials: N
authors.lastname: Kandiah
authors.forename: Philip
authors.initials: P
authors.lastname: Yap
mesh_terms: D000368:Aged; D002681:China / Q000208:ethnology; D003071:Cognition; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000208:ethnology; D003937:Diagnosis, Differential; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012846:Singapore / Q000453:epidemiology