Comparison of alternate and original forms of the Montreal Cognitive Assessment (MoCA): an Italian normative study
The Montreal Cognitive Assessment (MoCA) is a screening test widely used in clinical practice and suited for detection of Mild Cognitive Impairment. Alternate forms of the MoCA were developed to avoid “learning effect” in serial assessments, and the present study aimed at investigating inter-form parallelism and at providing normative values for the Italian versions of MoCAs 2 and 3.
Three separate convenience samples were recruited: the first (n = 78) completed three alternate MoCA versions for ascertaining inter-form parallelism; the second (n = 302) and the third (n = 413) samples were administered MoCA 2 or 3 to compute normative data.
A three-step procedure complemented by confirmatory factor analysis and a mixed factorial ANOVA suggested that the three MoCA versions are not strictly parallel. Multiple linear regression analysis revealed that age and education significantly influenced MoCA 2 and 3 total scores. No significant effect of sex was found. From the derived linear equation, correction grids for MoCA 2 and 3 raw scores were built and equivalent scores computed. Inferential cutoff for adjusted scores, estimated using a non-parametric technique, were 17.49 for MoCA 2 and 18.34 for MoCA 3. Correlation analysis showed strong correlations of MoCA 2 (r = 0.69, p < .001) and MoCA 3 (r = 0.61, p < .001) adjusted total scores with MMSE adjusted scores.
The three MoCA forms are not strictly parallel. Specifically developed normative data must be adopted for using MoCA in serial cognitive assessments for clinical and research studies.
Key-wordsStatistical methods Norms Executive functions Aging Dementia Assessment
The authors thank Dr. Maria Rosaria Figliola, Dr. Domenico Vivarelli, Dr. Anita Sportiello, and UNITRE for their contribution in collecting data.
Compliance with ethical standards
Informed consent was obtained from all participants included in the study. The study was carried out in accordance with the Declaration of Helsinki on Ethical Principles for Medical Research.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x CrossRefGoogle Scholar
- 4.Godefroy O, Fickl A, Roussel M, Auribault C, Bugnicourt JM, Lamy C, Canaple S, Petitnicolas G (2011) Is the Montreal Cognitive Assessment superior to the mini-mental state examination to detect poststroke cognitive impairment? A study with neuropsychological evaluation. Stroke 42:1712–1716. https://doi.org/10.1161/STROKEAHA.110.606277 CrossRefGoogle Scholar
- 6.Santangelo G, Russo A, Trojano L, Falco F, Marcuccio L, Siciliano M, Conte F, Garramone F, Tessitore A, Tedeschi G (2016) Cognitive dysfunctions and psychological symptoms in migraine without aura: a cross-sectional study. J Headache Pain 17:76. https://doi.org/10.1186/s10194-016-0667-0 CrossRefGoogle Scholar
- 7.Skorvanek M, Goldman JG, Jahanshahi M, Marras C, Rektorova I, Schmand B, van Duijn E, Goetz CG, Weintraub D, Stebbins GT, Martinez-Martin P, members of the MDS Rating Scales Review Committee (2018) Global scales for cognitive screening in Parkinson's disease: critique and recommendations. Mov Disord 33:208–218. https://doi.org/10.1002/mds.27233 CrossRefGoogle Scholar
- 8.Damian AM, Jacobson SA, Hentz JG, Belden CM, Shill HA, Sabbagh MN, Caviness JN, Adler CH (2011) The Montreal Cognitive Assessment and the mini-mental state examination as screening instruments for cognitive impairment: item analyses and threshold scores. Dement Geriatr Cogn Disord 31:126–131. https://doi.org/10.1159/000323867 CrossRefGoogle Scholar
- 9.Wong GK, Lam SW, Wong A, Ngai K, Poon WS, Mok V (2013) Comparison of Montreal cognitive assessment and mini-mental state examination in evaluating cognitive domain deficit following aneurysmal subarachnoid haemorrhage. PLoS One 8:e59946. https://doi.org/10.1371/journal.pone.0059946 CrossRefGoogle Scholar
- 10.Oudman E, Postma A, Van der Stigchel S, Appelhof B, Wijnia JW, Nijboer TC (2014) The Montreal Cognitive Assessment (MoCA) is superior to the Mini Mental State Examination (MMSE) in detection of Korsakoff’s syndrome. Clin Neuropsychol 28:1123–1132. https://doi.org/10.1080/13854046.2014.960005 CrossRefGoogle Scholar
- 13.Tu QY, Jin H, Ding BR, Yang X, Lei ZH, Bai S, Zhang YD, Tang XQ (2013) Reliability, validity, and optimal cutoff score of the Montreal cognitive assessment (Changsha version) in ischemic cerebrovascular disease patients of human province, China. Dement Geriatr Cogn Dis Extra 3(1):25–36CrossRefGoogle Scholar
- 15.Federico A, Maier A, Vianello G, Mapelli D, Trentin M, Zanette G, Picelli A, Gandolfi M, Tamburin S (2015) Screening for mild cognitive impairment in Parkinson’s disease: comparison of the Italian versions of three neuropsychological tests. Parkinsons Dis 2015:681976Google Scholar
- 17.Costa AS, Fimm B, Friesen P, Soundjock H, Rottschy C, Gross T, Eitner F, Reich A, Schulz JB, Nasreddine ZS, Reetz K (2012) Alternate-form reliability of the Montreal cognitive assessment screening test in a clinical setting. Dement Geriatr Cogn Disord 33:379–384. https://doi.org/10.1159/000340006 CrossRefGoogle Scholar
- 19.Pirani A, Tulipani C, Neri M (2006) Montreal Cognitive Assessment, Italian version. http://www.mocatest.org/wp-content/uploads/2015/03/MoCA-Test-Italia-dati-normativi2.pdf
- 22.Santangelo G, Siciliano M, Pedone R, Vitale C, Falco F, Bisogno R, Siano P, Barone P, Grossi D, Santangelo F, Trojano L (2015) Normative data for the Montreal Cognitive Assessment in an Italian population sample. Neurol Sci 36:585–591. https://doi.org/10.1007/s10072-014-1995-y CrossRefGoogle Scholar
- 23.Bosco A, Spano G, Caffò AO, Lopez A, Grattagliano I, Saracino G, Pinto K, Hoogeveen F, Lancioni GE (2017) Italians do it worse. Montreal Cognitive Assessment (MoCA) optimal cut-off scores for people with probable Alzheimer's disease and with probable cognitive impairment. Aging Clin Exp Res 29:1113–1120. https://doi.org/10.1007/s40520-017-0727-6 CrossRefGoogle Scholar
- 24.Santangelo G, Siciliano M, Trojano L (2016) Montreal Cognitive Assessment, Italian alternate versions. http://www.mocatest.org/wp-content/uploads/2015/03/Italian-7.2.pdf for MoCA 2 http://www.mocatest.org/wp-content/uploads/2015/03/Italian-7.3.pdf for MoCA 3
- 25.Spinnler H, Tognoni G (1987) Standardizzazione e taratura italiana di test neuropsicologici. [Italian standardization and adjustment of neuropsychological tests]. Ital J Neurol Sci 6:8–20Google Scholar
- 29.Magni E, Binetti G, Bianchetti A, Rozzini R, Trabucchi M (1996) Mini-mental state examination: a normative study in Italian elderly population. Eur J Neurol 3:198–202. https://doi.org/10.1111/j.1468-1331.1996.tb00423.x CrossRefGoogle Scholar
- 31.Cohen JW (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates Publishers, HillsdaleGoogle Scholar
- 39.Ciesielska N, Sokołowski R, Mazur E, Podhorecka M, Polak-Szabela A, Kędziora-Kornatowska K (2016) Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol 50:1039–1052. https://doi.org/10.12740/PP/45368 CrossRefGoogle Scholar
- 41.Iavarone A, Ronga B, Pellegrino L, Loré E, Vitaliano S, Galeone F, Carlomagno S (2004) The Frontal Assessment Battery (FAB): normative data from an Italian sample and performances of patients with Alzheimer’s disease and frontotemporal dementia. Funct Neurol 19:191–195Google Scholar