Examining the Validity and Utility of Montreal Cognitive Assessment Domain Scores for Early Neurocognitive Disorders.
Li Chang Ang, Philip Yap, Sze Yan Tay and 2 others
PMID 36758620WHAT IT FOUND
MoCA domain scores lined up with standard cognitive tests and showed different patterns for Alzheimer's, Lewy body, and frontotemporal disease.
Use them with the MoCA total and clinical judgment, not as a stand-alone diagnosis.
Key findings
01After adjusting for other MoCA domains, domain scores showed the strongest relationships with standard cognitive tests of the same abilities, with coefficients from -0.13 to 0.43.
02In participants with mild cognitive impairment or early dementia, lower memory and orientation scores were linked to Alzheimer's disease, and lower language and executive scores were linked to frontotemporal lobar degeneration.
03In the mild cognitive impairment and early dementia group, Lewy body disease was linked to attention and visuospatial impairment, and vascular disease was linked to attention impairment.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
MoCA is shorter and less thorough than full neuropsychological testing, so it may miss subtle or ambiguous deficits. Some MoCA items count toward more than one domain, such as clock drawing, so a low score may not show exactly which ability is impaired. The study did not include behavioral observation or collateral history, which can be essential for diagnoses such as frontotemporal lobar degeneration. MoCA administration has no built-in check for whether the person tried hard, so low scores could reflect effort rather than cognition. The sample came from specialty Alzheimer's centers, not the general population, and was mostly Caucasian, so results may not apply to all communities. 11.8% of diagnoses were made by a single clinician rather than consensus, which may be less reliable.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not read these domain scores as a stand-alone way to diagnose the type of dementia. The study showed associations in a clinical database, and the authors say MoCA domain scores may not be detailed enough when vascular disease is suspected or cases are ambiguous.