This study was conducted in accordance with the Declaration of Helsinki and ethical approval was obtained from the Kowloon Central/Kowloon East Cluster Clinical Research Ethics Committee of the Hong Kong Hospital Authority.Īll subjects were assessed using HK-MoCA and Cantonese version of Mini-Mental State Examination (CMMSE) at the first visit. Lastly, patients diagnosed with an advanced stage of dementia, accordingly with Global Deterioration Scale (GDS) of six or above, were not recruited. Besides, persons with inability to use a pen or with communication barriers such as deafness or significant language or speech problem were also excluded. Patients were excluded if they had a history, as documented in medical records, of significant head trauma, subdural hematoma, neurodegenerative disorders, central nervous system infection, epilepsy, brain tumor, significant psychiatric disorders (such as major depression or schizophrenia), alcoholism, or substance abuse. They were divided into three groups: subjects with dementia, subjects who met the criteria for MCI, and cognitively normal controls (NC).
They were seen for suspected cognitive impairment and all of them had given informed consent. It recruited a total of 315 community-dwelling and Cantonese-speaking Chinese adults aged 60 years or above. This was a cross-sectional study conducted in a public hospital-based cognition clinic from August 2012 to June 2017. Therefore, this study aimed at examining whether such findings also apply to a more heterogenous group of subjects with cognitive impairment due to various causes among Chinese older adults. However, the applicability of these findings to other patients with non-vascular causes is not known. These results advised against the use of single cutoff scores of HK-MoCA on patients with cognitive impairment due to vascular cause. 6 The study reported that using norm-derived cutoff as reference, a single cutoff at 21/22 yielded a classification discrepancy of 55.8%, with the majority of the misclassifications being false positives and the highest rate among patients with the lowest education duration of zero to three years. However, another study raised the issue that the single cutoff score of HK-MoCA was associated with a substantially high misclassification rate especially in older and less-educated patients with stroke. 4, 5 A score of less than 22 is considered positive for screening and calls for further diagnostic assessment. In Hong Kong, a local version of MoCA, the Hong Kong version (HK-MoCA), was validated in Chinese older adults. 3 Demographically adjusted norms may help improve the diagnostic accuracy. Moreover, the one-point correction for education has been debated as insufficient to compensate for educational differences. 2 Some studies have revealed that the originally recommended cutoff score of 26 leads to a higher false positive misclassification especially on those with increasing age and/or low education. Systematic review highlighted the necessity for cross-cultural considerations when using the MoCA as a screening tool. 1 There is a one-point adjustment for individuals with formal education of 12 years or fewer.
The Montreal Cognitive Assessment (MoCA) is a brief, useful and validated cognitive screening instrument with a cutoff score of 26 to differentiate mild cognitive impairment (MCI) or dementia from normal. A cognitive screening measure with high sensitivity and specificity is essential for them to decide who needs a more detailed evaluation or make a referral for comprehensive geriatric assessments, including neuropsychological evaluations.
Individuals concerned about their memory loss are mostly seen by primary care physicians. Poor memory is one of the commonest presenting complaints and other features include disturbances of behaviour, language, mood, personality or perception. Dementia is a major neurodegenerative disorder and often begins with focal cognitive or behavioural disturbances.
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