Strengths and Limitations of the MoCA for Assessing Cognitive Functioning: Findings From a Large Representative Sample of Irish Older Adults.

Abstract

The Montreal Cognitive Assessment (MoCA) is a very widely used test for mild cognitive impairment. Differing recommendations have been made regarding its utility in providing a profile of performance across several cognitive domains. To examine the factor structure of the MoCA in a nationally representative population study of older Irish adults and evaluate its utility in providing domain-specific information. A cross-sectional analysis of wave 1 data from the Irish Longitudinal Study on Ageing was undertaken. Data from a subset of 2342 participants assessed using the MoCA were analyzed using both confirmatory factor analytic (CFA) and exploratory factor analytic (EFA) methods. Mean age was 72.64 (range 65 to 98), 53% female. The CFA provided evidence of adequate overall model fit for a previously proposed 6-factor model. In contrast, EFA yielded a 3-factor solution and test items cross-loaded onto a number of factors with no clear pattern of underlying cognitive domains. Using EFA to explore the 6-factor model yielded good fit, but again test items cross-loaded onto a number of factors with no clear pattern evident. Lack of concordance between the CFA and EFA findings demonstrates that the correspondence between individual tests and their assumed cognitive domains is not robust, reflecting at least in part a current lack of consensus on how core cognitive constructs are defined and on what subcomponents can be subsumed under different cognitive domains. The MoCA should not be viewed as a substitute for more in-depth neuropsychological assessment when domain-specific information is required.