MoCA cutoff score in relation to the functional assessment of seniors living in a rural Canadian community

• Published in: Canadian journal of rural medicine Vol. 21; no. 4; p. 101
• Main Authors: Doyon Dolinar, Rose-Marie, Pleta, Bemice A, Salmoni, Alan W, Johnson, Andrew M
• Format: Journal Article
• Language: English
• Published: India 22-09-2016
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Canada; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - physiopathology; Female; Humans; Independent Living; Male; Middle Aged; Neuropsychological Tests; Retrospective Studies; ROC Curve; Rural Population; Sensitivity and Specificity
• ISSN: 1488-237X
• DOI: 10.1016/S1203-7796(16)30306-1

Research suggests that the Montreal Cognitive Assessment (MoCA) normal cutoff score of 26 may not be appropriate for all populations and ages. We sought to determine an appropriate MoCA cutoff score for community-dwelling seniors living in a rural Canadian community.
We conducted a retrospective chart review at a health centre in rural northern Ontario. The sample included community-dwelling seniors presenting between Dec. 1, 2013, and July 31, 2015. We generated a receiver operating characteristic curve to evaluate MoCA cutoff scores in relation to functional assessment, using the dichotomous categories of "no deficiencies in activities of daily living/instrumental activities of daily living (ADL/IADL) and "deficiencies in ADL/IADL."
A total of 95 charts were included in the chart review. We identified MoCA scores of 20 (sensitivity 85%, specificity 62%) and 21 (sensitivity 77%, specificity 77%) as cutoff scores for the identification of impairment in this rural population.
Our results suggest the normal range in MoCA score for the community-dwelling rural senior to be between 22 and 30. Although the MoCA demonstrated satisfactory performance as a screening measure, the importance of including ADL and IADL functional assessments before making clinical decisions cannot be overemphasized.