Optimal cut scores on the MMSE for identification of cognitive impairment have been shown to differ across racial/ethnic and language groups 13, 14 and MMSE has been shown to exhibit low diagnostic utility for older adults in Mexico with low levels of education 15. As with the MoCA, MMSE scores have been demonstrated to be impacted by education, age, ethnicity, and language 11 and analysis of its psychometric properties with item-response theory (IRT) has shown measurement differences between the English and Spanish test versions 12.

The Mini Mental State Examination (MMSE) is one of the most widely used and researched cognitive screening instruments, and has shown a strong correlation with the MoCA 10. Cultural and linguistic characteristics, disparities in educational quality and attainment, and other factors may contribute to these differences 9. In addition, MoCA sub-scores have been shown to offer differing clinical utility by race/ethnicity, such that fewer MoCA subtests were predictive of consensus diagnosis of MCI/dementia in Hispanic/Latinx and African American individuals compared to non-Hispanic white individuals 8. For example, the use of race/ethnic-specific MoCA cut-scores has been shown to lead to better precision compared to universal cut-scores in classifying MCI and dementia in Hispanic/Latinx and African American patients 7. Several additional studies have suggested that the original MoCA cut-scores over-classify cognitive impairment in diverse samples 6. Community-based data have demonstrated different MoCA score distributions by race/ethnicity 5, suggesting that the originally-developed cut-scores 1 may over-classify cognitive impairment in some cognitively normal populations. This is a critical aspect of instrument validation and test fairness 4.Įvidence suggests that the MoCA may not reflect cognitive health equivalently across racial/ethnic groups. Despite availability of translated test versions and wide use in both clinical and research settings, examination of its validity across culturally and linguistically diverse groups is not established 3.

The Montreal Cognitive Assessment (MoCA) is a widely-used cognitive screening instrument, initially developed and validated in English and French in a Canadian sample 1 and subsequently translated and used in several additional languages, including Spanish ( 2, 3).

Moca test english 7 1.pdf