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Correcting the MoCA for Education: Effect on Sensitivity

Published online by Cambridge University Press:  23 September 2014

Genevieve Gagnon ,
Kevin T. Hansen ,
Sarah Woolmore-Goodwin ,
Iris Gutmanis ,
Jennie Wells ,
Michael Borrie  and
Jennifer Fogarty
Genevieve Gagnon
Affiliation:
Centre for Addiction and Mental Health, University of Toronto, Toronto Department of Psychiatry, University of Toronto, Toronto
Kevin T. Hansen
Affiliation:
Specialized Geriatric Services, St. Joseph's Health Care, London
Sarah Woolmore-Goodwin
Affiliation:
Specialized Geriatric Services, St. Joseph's Health Care, London
Iris Gutmanis
Affiliation:
Lawson Health Research Institute, St. Joseph's Health Care, London Specialized Geriatric Services, St. Joseph's Health Care, London Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario Faculty of Medicine, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario
Jennie Wells
Affiliation:
Lawson Health Research Institute, St. Joseph's Health Care, London Specialized Geriatric Services, St. Joseph's Health Care, London Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario
Michael Borrie
Affiliation:
Lawson Health Research Institute, St. Joseph's Health Care, London Specialized Geriatric Services, St. Joseph's Health Care, London Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario Consortium of Canadian Centres for Clinical Cognitive Research (C5R), Calgary, Alberta, Canada
Jennifer Fogarty*
Affiliation:
Lawson Health Research Institute, St. Joseph's Health Care, London Specialized Geriatric Services, St. Joseph's Health Care, London Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario
*
St. Joseph's Health Care London, 801 Commissioners Road East, London, Ontario, N6C 5J1, Canada. Email: jennifer.fogarty@sjhc.london.on.ca
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Abstract:

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Objective:

The goal of this study was to quantify the impact of the suggested education correction on the sensitivity and specificity of the Montreal Cognitive Assessment (MoCA).

Method:

Twenty-five outpatients with dementia and 39 with amnestic mild cognitive impairment (aMCI) underwent a diagnostic evaluation, which included the MoCA. Thirty-seven healthy controls also completed the MoCA and psychiatric, medical, neurological, functional, and cognitive difficulties were ruled out.

Results:

For the total MoCA score, unadjusted for education, a cut-off score of 26 yielded the best balance between sensitivity and specificity (80% and 89% respectively) in identifying cognitive impairment (people with either dementia or aMCI, versus controls). When applying the education correction, sensitivity decreased from 80% to 69% for a small specificity increase (89% to 92%). The cut-off score yielding the best balance between sensitivity and specificity for the education adjusted MoCA score fell to 25 (61% and 97%, respectively).

Conclusions:

Adjusting the MoCA total score for education had a detrimental effect on sensitivity with only a slight increase in specificity. Clinically, this loss in sensitivity can lead to an increased number of false negatives, as education level does not always correlate to premorbid intellectual function. Clinical judgment about premorbid status should guide interpretation. However, as this effect may be cohortspecific, age and education corrected norms and cut-offs should be developed to help guide MoCA interpretation.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 5 , September 2013 , pp. 678 - 683
Copyright
Copyright © The Canadian Journal of Neurological 2013

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