Validating the MoCA for screening 3 73 Table 1: key demographic and clinical characteristics Clinical population Primary outcome Secondary outcome Total Referred (a) Dementia (b) MCI (c) NoCI (d) Healthy Controls (e) Statistical difference p<0.001 Variable / n 693 81 153 459 84 Age (SD) range 72.5 (7.8) 53-94 77.3 (7,5) 59-94 73.9 (8.0) 53-93 71.3 (7.3) 58-92 73.5 (7.8) 60-91 b>c>d Education <12 (%) 47 52 53 43 45 No sig. Sex F (%) 62 63 57 63 59 No sig. GAF (SD) 53.3 (12.3) 52 (10.2) 57 (12.8) 52 (12.4) 84 (5.9) a<e b,d<c GDS15 (SD) 8.4 (4.3) 6.6 (4.9) 7.7 (4.7) 8.6 (4,3) 1.3 (2.0) a>e MoCA (SD) 22.1 (4.7) 16.5 (4.0) 20.9 (3.8) 23.5 (4.2) 26.5 (2.6) a<e b<c<d range 3-30 5-26 3-28 3-30 20-30 Education and sex were compared between b,c,d and between a,e with a Chi2 test. Groups b,c,d and were compared with ANOVA, Groups a,e were compared with t-test. MCI: Mild Cognitive Impairment; NoCI: No Cognitive Impairment; GAF: Global Assessment of Functioning; GDS15: Geriatric Depression Scale 15 question version; MoCA: Montreal Cognitive Assessment. 3.3.3 MoCA outcome The mean MoCA-scores differed significantly between groups; the differences in average MoCA scores between the individual referred groups were significant (p=0.000), as well as those for the secondary outcome between combined total referred group and the HC (p=0.000). The standard deviations (MCI towards NoCI) and range (all groups) of the referred groups did overlap, and showed a wide distribution (table 1). The internal consistency of the MoCA, as expressed by the Cronbachs alpha on the standardized items (0.761), was good. All 12 items of the MoCA contribute to a positive Cronbachs alpha, as no item “if item deleted” gives a higher outcome (0.708- 0.737). The results of the ROC analysis, for clinical situations, are shown in figure 2: a) Dementia versus No-Dementia (MCI + NoCI) and b) Cognitive Impairment (CI= MD + MCI) versus NoCI. Table 2 displays the AUCs of these and additional analyses, as well as their sensitivity and specificity at the literature-recommended cut-off scores of 26 and 21. All AUCs were significantly different from 0.5 (no diagnostic accuracy), p<0.001. The AUCs with HC as secondary comparison ranged between 0.90 and 0.98, an excellent accuracy. The MoCA performed less well in a clinical setting, with AUCs between 0.70-0.87.
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