The Application Of Montreal Cognitive Assessment In Screening Of Mild Cognitive Impairment Among The Elderly In Changsha City

Objective:The purposes of this study were to establish the reliability and validity of Beijing version of the Montreal cognitive assessment (MoCA); to explore the suitable cut-off-points for the old people who were in different educational levels in Changsha; to understand the prevalence of mild cognitive impairment (MCI) of the aged people in the communities in Changsha, to provide a tool for screening elders with mild cognitive impairment (MCI).Methods:The research was a cross-section investigation,1764aged60years and over in five communities in Changsha were selected using the multi-stage random cluster sampling method. The instruments selected to screen MCI were:MMSE, CDR, ADL, GDS, MoCA, and the clinical diagnosis were made by clinical neurological experts according to the clinical MCI standards. Statistic methods such as descriptive statistics, Cronbach’s a, Pearson’s correlations, confirmation factor analysis, receiver operating characteristic curve(ROC), and regression analysis were performed by SPSS16.0and Amos7.0.Results:The Cronbach’s a and the test-retest reliability coefficient of the Beijing version of MoCA were0.782and0.972, respectively. The Pearson’s coefficient between MoCA and MMSE was0.579(P<0.01), the correlated coefficient among the subscales and the total scale were0.433～0.729; the confirmation factor analysis demonstrated the χ2/df were2.682, the root-mean-square error of approximation (RMSEA) were0.05, the indexes of goodness-of-fit index (GFI), normed fit index (NFI), incremental fit index (IFI), Tucker-Lewis index (TLI), comparative fit index (CFI) were0.05,0.909,0.901,0.917,0.920,0.928, respectively. The cut-off-points of the Beijing version of MoCA were different with cultural levels:23for illiteracy,24for primary educational level,25for junior educational level or above. The sensitivity and the specificity were0.871and0.967, respectively; the Kappa value was0.763; the cut-off-points screening results were consistent with the clinical findings. The prevalence of MCI among the elderly in the communities of Changsha was16.27%, logistic regression demonstrated that age, education level, living condition entered the regression equation(P<0.05).Conclusion:The Beijing version of MoCA was an acceptable tool with good validity and reliability, as well as high sensitivity and specificity for screening MCI in Changsha. The cut-off-points of the Beijing version of MoCA for screening MCI were different with education levels:23for illiteracy,24for primary educational level,25for junior educational level or above. The prevalence of MCI among the aged in the communities of Changsha was at medium level, the elderly with advanced age, low educational level and living alone as the key population need to be protected more for high risk of suffering from MCI.