Clinical value of the Montreal Cognitive Assessment free recall condition alone versus cued recall and recognition conditions to detect true memory impairment

Abstract

The Montreal Cognitive Assessment (MoCA) is widely used as a screener to characterize cognition. Although only the delayed free recall condition is required for administration, performance on the optional cued recall and multiple-choice recognition conditions may improve diagnostic accuracy over free recall alone. Data on 719 individuals with MCI and 601 controls were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. The Rey Auditory Verbal Learning Test (AVLT) delayed free recall condition was used as the gold standard of memory status. Participants with T-scores ≤30 (≤2 SDs below the mean) were classified as memory “impaired.” Binary logistic regressions assessed if combined MoCA cued recall/recognition predicted impaired delayed recall on the AVLT beyond the contribution of MoCA free recall. Results showed that MoCA free recall predicted AVLT delayed recall, and that the addition of combined MoCA cued recall/recognition improved the ability to detect impaired AVLT recall, with a better overall model fit. The combined MoCA cued recall/recognition score also had higher specificity and likelihood ratios in detecting memory impairment than MoCA free recall, while higher sensitivity values were present for free recall. Thus, the additional administration of the MoCA cued recall and recognition is recommended.