Validity and reliability of two alternate versions of the Montreal Cognitive Assessment (Hong Kong version) for screening of Mild Neurocognitive Disorder

Adrian Wong, Stanley Yiu, Ziad Nasreddine, Kam-Tat Leung, Alexander Lau, Yannie O Y Soo, Lawrence Ka-Sing Wong, Vincent Mok, Adrian Wong, Stanley Yiu, Ziad Nasreddine, Kam-Tat Leung, Alexander Lau, Yannie O Y Soo, Lawrence Ka-Sing Wong, Vincent Mok

Abstract

Objective: Repeated testing using the Montreal Cognitive Assessment (MoCA) increases risks for practice effects which may bias measurements of cognitive change. The objective of this study is to develop two alternate versions of the MoCA (Hong Kong version; HK-MoCA) and to investigate the validity and reliability of the alternate versions in patients with DSM-5 Mild Neurocognitive Disorder (Mild NCD) and cognitively healthy controls.

Methods: Concurrent validity and inter-scale agreement were examined by Pearson correlation of the total scores between the original and alternate versions and the Bland-Altman Method. Criterion validity of the two alternate versions in differentiating patients with Mild NCD was tested using receiver operating characteristic curve (ROC) analysis. One-month test-retest and inter-rater reliability were examined in 20 participants. Internal consistency of the alternate versions was measured by the Cronbach's α.

Results: 30 controls (age 73.4 [4.5] years, 60% female) and 30 patients (age 75.4 [5.5] years, 73% female) with Mild NCD were recruited. Both alternate versions significantly correlated with the original version (r = 0.79-0.87, p<0.001). Mean differences of 0.17 and -0.40 points were found between the total scores of the alternate with the original versions with a consistent level of agreement observed throughout the range of cognitive abilities. Both alternate versions significantly differentiated patients with Mild NCD from healthy controls (area under ROC 0.922 and 0.724, p<0.001) and showed good one-month test-retest reliability (intra-class correlation [ICC] = 0.92 and 0.82) and inter-rater reliability (ICC = 0.99 and 0.87) and high internal consistency (Cronbach α = 0.79 and 0.75).

Conclusion: The two alternate versions of the HK-MoCA are useful for Mild NCD screening.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Scatterplots depicting relationships between HK-MoCA-O…
Fig 1. Scatterplots depicting relationships between HK-MoCA-O with HK-MoCA-A1 (panel a) and HK-MoCA-A2 (panel b).
HK-MoCA-A1 (r = 0.87, p<0.001) and HK-MoCA-A2 (r = 0.79, p<0.001).
Fig 2. Bland Altman plots showing interscale…
Fig 2. Bland Altman plots showing interscale agreement between HK-MoCA-O with HK-MoCA-A1 (panel 2a) and HK-MoCA-A2 (panel 2b).
Fig 3. ROC curves for HK-MoCA-O, HK-MoCA-A1…
Fig 3. ROC curves for HK-MoCA-O, HK-MoCA-A1 and HK-MoCA-A2 in differentiating patients with Mild NCD from healthy controls.
Note that the individual ROC curves are derived from different samples (n = 60 for HK-MoCA-O, n = 30 HK-MoCA-A1 and n = 30 for HK-MoCA-A2 and combined in a single graph as shown here. AUCs are 0.839, p<0.001 for MoCA, 0.922, p<0.001 for HK-MoCA-A1 and 0.724, p<0.05 for HK-MoCA-A2.

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Source: PubMed

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