![]() To date, the generalizability of these findings to US Hispanics has not been demonstrated. The results imply that to increase the accuracy of interpretation of the MoCA in participants of Hispanic background, score adjustments might be necessary for those with little formal education. Several MoCA items were influenced by levels of education: cube copying, clock drawing, serial subtraction, letter fluency, and abstraction. In that study, the MoCA total score showed a progressive increment across the following three educational levels in nondemented individuals: illiterates and those with incomplete primary schooling (5 years education) obtained a mean MoCA score of 21.6. To date, only one study has reported using the Spanish version of the MoCA in a sample of Colombian elders (mean education 4.8 years). In spite of an ongoing emphasis on optimizing the recruitment of Hispanic participants for dementia research, there is still a dearth of research on the utility of the MoCA in Spanish speakers. ![]() In order to improve our ability to detect the earliest cognitive changes in this ethnic group, a more thorough understanding of the testing behavior of screening instruments in these populations is required. According to the Alzheimer's Association's 2013 ‘Alzheimer's disease facts and figures' report, older Hispanics are about 1.5 times as likely to have Alzheimer's disease (AD) and other dementias compared to older Caucasians but less likely than older Caucasians to have a diagnosis. Hispanics living in the US represent a heterogeneous group, consisting of people of diverse linguistic and cultural traditions from the Caribbean, South America, Central America, and Mexico. By 2020, 20% of the elderly population in California will be Hispanic. Hispanics are the most rapidly growing group in the US. The MoCA has been translated into approximately 37 languages (available at ). The use of cognitive instruments in minorities or other populations outside the group in which it was originally developed can require linguistic translation and often also cultural adaptation. For example, studies carried out in the US, China, and Colombia all reported educational effects on MoCA performance which may not be fully compensated by the suggested score adjustments. Score adjustments based on relatively homogeneous populations such as these can be sample specific and may not be generalizable to populations with diverse cultural, linguistic, and socioeconomic backgrounds. No score adjustment was suggested for those with <4 years of education. ![]() More recently, in recognition of the necessity for further score correction in individuals with a lower education, the same group recommended a revised correction of +1 point for 10-12 years of education and +2 points for 4-9 years of education. , was derived from a validation sample residing in Montreal with a mean educational level of approximately 12 years. The initial 1-point correction for ≤12 years of education, suggested by Nasreddine et al. Performance on the MoCA has been demonstrated to be dependent on the educational level. The Montreal Cognitive Assessment (MoCA) is a 10- to 20-min screening test designed to assist clinicians in detecting early or minor cognitive impairment. Overall, the Spanish version of the MoCA maintained adequate psychometric properties in this population. Conclusion: A compensation of 3-4 points was needed for <6 years of education. Cube copying, sentence repetition, delayed recall, and orientation were most sensitive to cognitive impairment due to AD. Results: We found that with progressive compensation added for those with lower education, unexplained residuals decreased and education-residual association moved to zero, suggesting that more compensation was necessary to better adjust MoCA scores in those with a lower educational level. The interval reliability of the MoCA as well as item discrimination and item validity were examined. ![]() Sensitivity and specificity analyses were performed for the raw and each adjusted score. We examined the pattern of diagnosis-adjusted MoCA residuals in relation to education and compared four alternative score adjustments using bootstrap sampling. Methods: We analyzed data from 50 Spanish-speaking participants. The purpose of this study was to identify how to best adjust MoCA scores and to identify MoCA items most sensitive to cognitive decline in incipient Alzheimer's disease (AD) in a Spanish-speaking population with varied levels of education. Background/Aims: Performance on the Montreal Cognitive Assessment (MoCA) has been demonstrated to be dependent on the educational level. ![]()
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