title: Strengths and Limitations of the MoCA for Assessing Cognitive Functioning: Findings From a Large Representative Sample of Irish Older Adults.
abstract: BACKGROUND
  The Montreal Cognitive Assessment (MoCA) is a very widely used test for mild cognitive impairment. Differing recommendations have been made regarding its utility in providing a profile of performance across several cognitive domains.
  
  
  OBJECTIVE
  To examine the factor structure of the MoCA in a nationally representative population study of older Irish adults and evaluate its utility in providing domain-specific information.
  
  
  METHODS
  A cross-sectional analysis of wave 1 data from the Irish Longitudinal Study on Ageing was undertaken. Data from a subset of 2342 participants assessed using the MoCA were analyzed using both confirmatory factor analytic (CFA) and exploratory factor analytic (EFA) methods.
  
  
  RESULTS
  Mean age was 72.64 (range 65 to 98), 53% female. The CFA provided evidence of adequate overall model fit for a previously proposed 6-factor model. In contrast, EFA yielded a 3-factor solution and test items cross-loaded onto a number of factors with no clear pattern of underlying cognitive domains. Using EFA to explore the 6-factor model yielded good fit, but again test items cross-loaded onto a number of factors with no clear pattern evident.
  
  
  CONCLUSIONS
  Lack of concordance between the CFA and EFA findings demonstrates that the correspondence between individual tests and their assumed cognitive domains is not robust, reflecting at least in part a current lack of consensus on how core cognitive constructs are defined and on what subcomponents can be subsumed under different cognitive domains. The MoCA should not be viewed as a substitute for more in-depth neuropsychological assessment when domain-specific information is required.
authors.affiliation: Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland rcoen@stjames.ie.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Coen
authors.affiliation: TILDA (The Irish Longitudinal Study on Ageing), Lincoln Gate, Trinity College Dublin, Dublin, Ireland.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Robertson
authors.affiliation: TILDA (The Irish Longitudinal Study on Ageing), Lincoln Gate, Trinity College Dublin, Dublin, Ireland.
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Kenny
authors.affiliation: TILDA (The Irish Longitudinal Study on Ageing), Lincoln Gate, Trinity College Dublin, Dublin, Ireland.
authors.forename: Bellinda L
authors.initials: BL
authors.lastname: King-Kallimanis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D003071:Cognition / Q000502:physiology*; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000523:psychology; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards*; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012680:Sensitivity and Specificity
keywords: MoCA; cognitive domains; factor analysis; neuropsychological assessment