Montreal Cognitive Assessment and Modified Mini Mental State Examination in African Americans.

Kaycee M Sink,Joseph A Maldjian,Donald W Bowden,Suzanne Craft,S Carrie Smith,Barry I Freedman,Jianzhao Xu,Jasmin Divers

doi:10.1155/2015/872018

Abstract

Background. Sparse data limit the interpretation of Montreal Cognitive Assessment (MoCA) scores, particularly in minority populations. Additionally, there are no published data on how MoCA scores compare to the widely used Modified Mini Mental State Examination (3MSE). We provide performance data on the MoCA in a large cohort of African Americans and compare 3MSE and MoCA scores, providing a “crosswalk” for interpreting scores. Methods. Five hundred and thirty African Americans with type 2 diabetes were enrolled in African American-Diabetes Heart Study-MIND, a cross-sectional study of cognition and structural and functional brain imaging. After excluding participants with possible cognitive impairment (n = 115), mean (SD) MoCA and 3MSE scores are presented stratified by age and education. Results. Participant mean age was 58.2 years (range: 35-83); 61% were female; and 64.9% had >12 years of education. Mean (SD) 3MSE and MoCA scores were 86.9 (8.2) and 19.8 (3.8), respectively. 93.5% of the cohort had a “positive” screen on the MoCA, scoring <26 (education-adjusted), compared with 47.5% on the 3MSE (cut-point < 88). A 3MSE score of 88 corresponded to a MoCA score of 20 in this population. Conclusion. The present data suggest the need for caution when applying proposed MoCA cutoffs to African Americans.

Highlights

With the aging population there is a concomitant diversification of the United States such that, by 2050, it is predicted that the proportion of ethnic minority older adults (≥65) will nearly double [1]
type 2 diabetes (T2D) was diagnosed in those with clinical disease onset after 30 years of age in the absence of diabetic ketoacidosis and in the setting of (a) active medical treatment, (b) fasting blood sugar > 126 mg/dL (7 mmol/L) or nonfasting blood sugar > 200 mg/dL (11.1 mmol/L), or (c) hemoglobin A1c (HbA1c) > 6.5%
Age and education were significantly associated with performance on the Montreal Cognitive Assessment (MoCA), emphasizing the importance of basing conclusions on stratified data

Summary

Introduction

With the aging population there is a concomitant diversification of the United States such that, by 2050, it is predicted that the proportion of ethnic minority older adults (≥65) will nearly double (from 19.7% in 2012 to 39.1% in 2050) [1]. Interpretation of MoCA scores in research settings and in diverse populations remains limited by sparse data and lack of comparative data with other tests. The Dallas Heart Study cohort is ethnically diverse; the published data does not provide race-/ethnicity-specific norms based on age or education. This limits the usefulness of the MoCA in minority patients and research participants. Sparse data limit the interpretation of Montreal Cognitive Assessment (MoCA) scores, in minority populations. After excluding participants with possible cognitive impairment (n = 115), mean (SD) MoCA and 3MSE scores are presented stratified by age and education. The present data suggest the need for caution when applying proposed MoCA cutoffs to African Americans

Objectives

Methods

Results

Conclusion