ArticleJournal of the American Geriatrics Society2024
Is the Montreal cognitive assessment culturally valid in a diverse geriatric primary care setting? Lessons from the Bronx.
Article in Journal of the American Geriatrics Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 11 citations in OpenAlex.
- Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial.Nature medicine · 2024Trial
- Ultraprocessed Food Intake and Adiposity, Vascular Brain Injury, and Cognition in Middle-Aged Adults.JAMA network open · 2026Article
- The Montreal Cognitive Assessment at the Framingham Heart Study: A Re-Examination of the Norms.Brain and behavior · 2026Article
- A systematic review of the association between phase angle and cognitive function among older adults.GeroScience · 2026Review
- Identifying individuals at risk of cognitive decline: cross-sectional analysis of variability in neuropsychological test scores among community-dwelling older adults.BMC public health · 2026Article
- Montreal Cognitive Assessment (MoCA) Scale: Strengths, Limitations, and Implication for Clinical Practice.Iranian journal of psychiatry · 2026Review
- A pilot study of at-home online cognitive screening prior to primary care wellness visits for older adults.Frontiers in digital health · 2026Article
- Optimal cutoff, cognitive impairment diagnostic performance, reliability and concurrent validity of the Ascertaining Dementia 8 (AD8) questionnaire among Latinos.medRxiv : the preprint server for health sciences · 2025Article
- Screening for Post-Stroke Cognitive Impairment in Sub-Saharan Africa: A Good IDEA?Brain sciences · 2025Article
- Montreal Cognitive Assessment (MoCA) use in general practice for the early detection of cognitive impairment: a feasibility study.BJGP open · 2025Article
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Authors and funding
6 authors at 2 institutions in 1 country.
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Abstract
backgroundEfficacy and validity of the MoCA for cognitive screening in ethnoculturally and linguistically diverse settings is unclear. We sought to examine the utility and discriminative validity of the Spanish and English MoCA versions to identify cognitive impairment among diverse community-dwelling older adults.
methodsParticipants aged ≥65 with cognitive concerns attending outpatient primary care in Bronx, NY, were recruited. MoCA and neuropsychological measures were administered in Spanish or English, and a neuropsychologist determined cognitive status (normal with subjective cognitive concerns [SCC], mild cognitive impairment [MCI], and dementia). One-way ANOVA compared cognitive statuses. ROC analyses identified optimal MoCA cutpoints for discriminating possible cognitive impairment.
resultsThere were 231 participants, with mean age 73, 72% women, 43% Hispanic; 39% Black/African American; 113 (49%) completed testing in English and 118 (51%) in Spanish. Overall MoCA mean was 17.7 (SD = 4.3). Neuropsychological assessment identified 90 as cognitively normal/SCC, average MoCA 19.9 (SD = 4.1), 133 with MCI, average MoCA 16.6 (SD = 3.7), and 8 with dementia, average MoCA 10.6 (SD = 3.1). Mean English MoCA average was 18.6 (SD = 4.1) versus Spanish 16.7 (SD = 4.3). The published cutpoint ≤23 for MCI yielded a high false-positive rate (79%). ROC analyses identified ≤18.5 as the score to identify MCI or dementia using the English MoCA (65% sensitivity; 77% specificity) and ≤16.5 for the Spanish MoCA (64% sensitivity;73% specificity) in this sample of older adults with cognitive concerns.
conclusionsCurrent MoCA cutpoints were inappropriately high in a culturally/linguistically diverse urban setting, leading to a high false-positive rate. Lower Spanish and English MoCA cutpoints may improve diagnostic accuracy for identifying cognitive impairment in this group, highlighting the need for the creation and validation of accurate cognitive screeners for ethnoculturally and linguistically diverse older adults.
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