April 1, 2011-August 13, 2013
The Montreal Cognitive Assessment (MoCA) is an instrument that aids clinicians to detect mild cognitive impairment. Its Pilipino version, called the Montreal Cognitive Assessment -- Philippines (MoCA-P), is now available at www.mocatest.org (Phase | of this study).
OBJECTIVE. Phase 2 was conducted to determine the diagnostic validity of the MoCA-P among community dwelling Filipino elderly.
METHOD: In this cross-sectional study, 1,460 elderly of which 1,385 participated were recruited from Marikina City by proportionate random sampling. Trained psychologists administered the MoCA-P and a battery of tests to determine cognitive and behavioral function, while the physician who was blinded to the results of the cognitive tests, provided diagnosis of control or probable Alzheimer's Disease (AD) based on the NINCDS- ADRDA criteria. After excluding subjects who were illiterate and therefore could not complete the MoCA-P, those whose primary language was not Pilipino and have difficulty comprehending tests instructions in Pilipino, those who did not complete the test and those who had concurrent medical or neurologic conditions that could confound test results or case diagnosis such as visual and hearing impairment, stroke, depression, Parkinson's disease, history of traumatic brain injury, hypothyroidism, seizures, psychiatric conditions, use of cognitive impairing medications, and those with MCI (cognitive impairment but no dementia), 606 comprised the test sample for analysis (509 controls, 97 AD cases).
RESULTS: The mean age was 68.9+6.51, majority were female (67.8%), and they attained high school level with mean years of education of 9.544+3.747, Mean age for control and AD was 67.89+ 5.77 and 74.474+6.35 respectively, while the mean years of education was 9.93+ 3.50 and 7.54+ 4.33 respectively. Analysis of variance showed the probable AD group was older (p< .05) and had lower education (p< .05). Cases were in the mild stage by the CDR. The best cut-off score to differentiate controls from probable AD was 20/21, with a sensitivity of 0.835 and a specificity of 0.723, and area under the curve (AUC) of 0.89 (p <0.001). The positive likelihood and negative likelihood ratios obtained 3.01 and 0.23 respectively. Pre-test and post-test odds were 0.0951 and 0.2224 respectively. Logistic regression analysis revealed that the odds of getting a positive MoCA-P (score < 20) increased with increasing age and education
CONCLUSION: The MoCA-P is a valid instrument for the early detection of probable AD among the Filipino elderly.