A Systematic Review On The Optimal Cut-off Value Of Montreal Cognitive Assessment(MoCA)for Mild Cognitive Impairment(MCI)in Chinese Middle Aged And Elderly People

Objective To evaluate screening accuracy of Montreal cognitive assessment(MoCA)for mild cognitive impairment(MCI)in Chinese middle aged and elderly people using systematic review and Meta-analysis on accuracy studies of MoCA.To identify the optimal cut-off values from multiple potential cut-off points based on their pooled accuracy indice.Methods Databases including PubMed,EMbase,The Cochrane Library(Issue 5,2016),OVID,CNKI,VIP,WanFang Data,CBM were searched for diagnostic tests about MoCA for MCI from April 9th 2005 to December 31st 2015.,Two reviewers independently screened literatures according to the inclusion and exclusion criteria,extracted data and assessed the methodological quality by QUAD AS-2 tool.Two models,The Bivariate Random effects Meta Analysis(BRMA.Stata 14.0)and Multivariate Random Effects Model(MREM,software R3.3.2),were used for estimated pooled accuracy indice of cut-off value 20/21-27/28.The best cutoff value is judged by the area under the SROC or Youden index,the pooled sensitivity,pooled specificity and their confidence interval.·Results A total of 27 studies conducted in community setting or hospital-based were included,involving 5 755 participants with mean ages from 60 to 80 years old.Among them,1 997 were diagnosed as MCI patients by Petersen criteria.The results of BRMA showed that the most accurate cut-off points were 23/24-25/26 with each of the pooled sensitivity 0.85(95%CI:0.66-0.94),0.88(95%CI:0.77-0.94)and 0.96(95%CI:0.93-0.97)respectively;and each of the pooled specificity 0.96(95%CI:0.80-0.99),0.92(95%CI:0.74-0.98),0.83(95%CI:0.75-0.89)respectively.And MREM indicated a slightly difference in the most accurate cut-off points of 23/24-24/25.The corresponding pooled sensitivities by MREM was 0.83(95%CI:0.74-0.89)and 0.90(95%CI:0.85-0.94),and the pooled specificities were 0.93(95%CI:0.87-0.96)and 0.85(95%CI:0.75-0.91).Conclusion The optimal cut-off values of MoCA for screening MCI by Petersen criteria among Chinese middle aged and elderly people in the community or hospital settings were in the range of 23/24-25/26.