Carolien Zeetsen

29 CHAPTER Psychometric properties of the MoCA in healthy participants 2 Introduction The Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) is one of many available cognitive screening instruments. The screener contains 12 items measuring seven cognitive domains: executive functioning; visuospatial abilities; language; attention, concentration and working memory; abstract reasoning; memory and orientation. Recently, the Memory Index Score (MoCA–MIS) was developed as an additional clinical outcome measure to assess the severity of memory impairments (Julayanont et al., 2014). The MoCA was developed to be more sensitive to mild cognitive impairment in geriatric populations than other screeners, like the Mini Mental State Examination (MMSE; Folstein et al., 1975), and has been translated into nearly 100 languages. Besides geriatrics, the MoCA is widely used in, for instance, substance use, HIV and hepatitis C (Copersino et al., 2009; Bassiony et al., 2015; Janssen et al., 2015; Bruijnen et al., 2016). Although the MoCA has gained wide support, research focussing on its psychometric properties, such as alternate–form–, test– retest– and inter–rater reliability, has yielded mixed findings. Moreover, the influence of educational attainment, age and sex on the test performance has been under debate. A short overview of these mixed findings is discussed below (see also Julayanont et al., 2013). With respect to educational attainment, Nasreddine et al. (2005) found that years of education affect MoCA performance. As a result, they suggested to add one ‘correction point’ to scores of individuals with 12 years of education or less. Bruijnen, Jansen, et al. (2019) recently proposed a more fine–grained correction method based on the level of education, rather than its duration, where individuals with a low level of education receive two additional points and those with an average level of education receive one additional point. Only one study correlated MoCA scores with general intellectual abilities and found a correlation of 0.64 (Sugarman & Axelrod, 2014). With respect to age, (Nasreddine et al., 2005) in their study in healthy adults between 55 and 85, did not find this characteristic to be of influence on MoCA performance. However, recent studies have demonstrated a negative correlation between age and MoCA scores in a slightly wider age range of 50–100 years (Malek–Ahmadi et al., 2015; Oren et al., 2015; Yancar Demir & Özcan, 2015; Apolinario et al., 2018). Also, an interaction effect between age and education was found, in which younger participants with higher education levels had higher MoCA scores, compared to older participants with lower education levels (Zheng et al., 2012). Normative data correcting for age, education and sex have been presented for several translations (Larouche et al., 2016; Ojeda et al., 2016; Borland et al., 2017; Thomann et al., 2018), while others found no effect of sex on MoCA performance (Zheng et al., 2012; Santangelo et al., 2015; Kopecek, Stepankova, et al., 2017; Apolinario et al., 2018). Although there are some studies presenting normative data, these are currently not as widely used as the aforementioned correction method by Nasreddine et al. (2005).