Carolien Zeetsen

40 identify any differences for the latter could be explained by the thorough checking of scores and the conservative scoring method that was used, eliminating ambiguities in scoring and possible inter–rater differences influencing results (Cumming et al., 2020). Similarly strict scoring criteria are embedded in the instructions of the recently published MoCA version 8 (i.e. ‘all lines meet with little or no space’ and ‘the figure’s orientation in space must be preserved’). The systematic differences found between the sentences may be the outcome of the adaptation and translation process into Dutch resulting in somewhat longer sentences for alternate versions 7.2 and 7.3 compared to the English– language alternate versions. Nasreddine et al. (2016) completely changed the sentences in the French versions instead of translating them from the original English–language versions. The systematic differences that were found on item level cancelled each other out when looking at the MoCA–TS, resulting in three equivalent versions. Focussing on the MoCA–DS, it should be taken into account that individuals may perform better on language (which includes the items animal naming and sentence repetition) and worse on abstract reasoning on version 7.1 compared to version 7.2 and/or 7.3 due to the abovementioned systematic differences, rather than actual changes in cognitive functioning over time. A good to excellent test–retest reliability was found for MoCA–TS between versions 7.1–7.2 and 7.1–7.3, respectively, in line with findings of other studies (Costa et al., 2012; Feeney et al., 2016; Nasreddine et al., 2016; Kopecek, Bezdicek, et al., 2017; Wu et al., 2017). The test–retest reliabilities can be used to compute Reliable Change Indices (RCI; Chelune et al., 1993) making the MoCA scores useful for monitoring change over time. The MoCA–MIS had poor to fair test–retest reliability, possibly due to a strong negative skewness of scores with ceiling performances on both versions in 31 participants (as opposed to 0 ceiling performances for MoCA–TS on both versions). However, in memory impaired individuals, the MoCA–MIS has been found to be a useful index of monitoring change over time. For instance, Julayanont et al. (2014) showed that the MoCA–MIS was a good predictor for conversion frommild cognitive impairment to Alzheimer’s disease. More research into the applicability of the MoCA–MIS in other clinical samples is needed, as compared to this sample of healthy individuals. For the other MoCA–DS and item scores, reliabilities ranged from poor to good, strengthening the fact that the MoCA is reliable and applicable as a global screen for cognitive functioning rather than as a tool to assess individual cognitive domains. Some strengths of the study are firstly, that it is the first one to assess the psychometric properties of all three versions of the Dutch translations of the MoCA. Secondly, we included the MoCA–MIS for which not much is known yet about the applicability of this score in clinical practice. Next, it was possible to include a large sample of healthy participants with a wide age range (including adults aged 18–50), and educational background, being representative for the general population. And finally, although we used the Dutch version of the MoCA, our