title: Montreal Cognitive Assessment: One Cutoff Never Fits All.
abstract: OBJECTIVE
  The objective of this study is to examine the discrepancy between single versus age and education corrected cutoff scores in classifying performance on the Montreal Cognitive Assessment (MoCA) in patients with stroke or transient ischemic attack.
  
  
  METHODS
  MoCA norms were collected from 794 functionally independent and stroke- and dementia-free persons aged ≥65 years. magnetic resonance imaging was used to exclude healthy controls with significant brain pathology and medial temporal lobe atrophy. Cutoff scores at 16th, 7th, and 2nd percentiles by age and education were derived for the MoCA and MoCA 5-minute Protocol. MoCA performance in 919 patients with stroke or transient ischemic attack was classified using the single and norm-derived cutoff scores.
  
  
  RESULTS
  The norms for the Hong Kong version of the MoCA total and domain scores and the total score of the MoCA 5-minute protocol are described. Only 65.1% and 25.7% healthy controls and 45.2% and 19.0% patients scored above the conventional cutoff scores of 21/22 and 25/26 on the MoCA. Using classification with norm-derived cutoff scores as reference, locally derived cutoff score of 21/22 yielded a classification discrepancy of ≤42.4%. Discrepancy increased with higher age and lower education level, with the majority being false positives by single cutoffs. With the 25/26 cutoff of the original MoCA, discrepancy further increased to ≤74.3%.
  
  
  CONCLUSIONS
  Conventional single cutoff scores are associated with substantially high rates of misclassification especially in older and less-educated patients with stroke. These results caution against the use of one-size-fits-all cutoffs on the MoCA.
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China.
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China.
authors.forename: Lorraine S N
authors.initials: LS
authors.lastname: Law
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China.
authors.forename: Wenyan
authors.initials: W
authors.lastname: Liu
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China.
authors.forename: Zhaolu
authors.initials: Z
authors.lastname: Wang
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China.
authors.forename: Eugene S K
authors.initials: ES
authors.lastname: Lo
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lau
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China.
authors.forename: Lawrence K S
authors.initials: LK
authors.lastname: Wong
authors.affiliation: From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China vctmok@cuhk.edu.hk.
authors.forename: Vincent C T
authors.initials: VC
authors.lastname: Mok
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards*; D011792:Quebec / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*
keywords: dementia; neuropsychology; stroke