Abstract
BackgroundThe availability of fine-grained, culture-specific psychometric outcomes can favor the interpretation of scores of the Montreal Cognitive Assessment (MoCA), the most frequently used instrument to screen for mild cognitive dysfunctions in both instrumental and non-instrumental domains. This study thus aimed at providing: (i) updated, region-specific norms for the Italian MoCA, by also (ii) comparing them to pre-existing ones with higher geographical coverage; (iii) information on sensitivity and discriminative capability at the item level.MethodsFive hundred and seventy nine healthy individuals from Northern Italy (208 males, 371 females; age: 63.4 ± 15, 21–96; education: 11.3 ± 4.6, 1–25) were administered the MoCA. Item Response Theory (IRT) was adopted to assess item difficulty and discrimination. Normative values were derived by means of the Equivalent Scores (ESs) method, applied to the MoCA and its sub-scales. Average ESs were also computed. Agreement with previous ESs classification was assessed via Cohen’s k.ResultsAge and education significantly predicted all MoCA measures except for Orientation, which was related to age only. No sex differences were detected when tested along with age and education. Substantial disagreements with previous ESs classifications were detected. Several items proved to be scarcely sensitive, especially the place item from Orientation and the letter detection task. Memory items showed high discriminative capability, along with certain items assessing executive functions and orientation.DiscussionItem-level information herewith provided for the Italian MoCA can help interpret its scores by Italian practitioners. Italian practitioners should consider an adaptive use of region-specific norms for the MoCA.
Highlights
Cognitive screening/first-level tests allow an estimate of global efficiency/functioning by adequately balancing between informativity and practicality of usage [1]
Age proved to be inversely related to both total (Spearman’s rs(579) = − 0.57; p < 0.001) and sub-test (−0.46 ≤ rs(535) ≤ −0.11; .014 ≤ p < 0.001) Montreal Cognitive Assessment (MoCA) scores, whereas a positive association with education was found for all measures: MoCA total (rs(579) = 0.55; p < 0.001) and sub-test (0.15 ≤ rs(535) ≤ 0.53; p≤.001) scores
When simultaneously tested, only age and education proved to be significantly predictive of all MoCA measures; MoCA-O was found to be predicted by age only (β = 0.19; p < 0.001)
Summary
Cognitive screening/first-level tests allow an estimate of global efficiency/functioning by adequately balancing between informativity and practicality of usage [1]. Compared to screening tests for dementia [2], those aimed at detecting mild-to-moderate cognitive impairment [3] may be harder for practitioners to interpret because of (a) the magnitude of the target construct (i.e., the deficit) being less obvious and (b) the amount of information provided by the test being limited [4]. The availability of fine-grained, culture-specific psychometric outcomes can favor the interpretation of scores of the Montreal Cognitive Assessment (MoCA), the most frequently used instrument to screen for mild cognitive dysfunctions in both instrumental and non-instrumental domains. This study aimed at providing: (i) updated, region-specific norms for the Italian MoCA, by (ii) comparing them to pre-existing ones with higher geographical coverage; (iii) information on sensitivity and discriminative capability at the item level. Italian practitioners should consider an adaptive use of region-specific norms for the MoCA
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