Participant data were obtained from the National Alzheimer’s Coordinating Center (NACC), a longitudinal referral-based or volunteer case series with 39 Alzheimer’s Disease Research Centers (ADRCs) supported by the United States (U.S.) National Institute on Aging/NIH ( NACC, 2010). We anticipate different cutoff points to reflect appropriate discrimination of cognitively normal from MCI participants across race. We predict that: 1) the suggested cutoff of ≤26/30 will inaccurately classify our sample, and 2) the MoCA will demonstrate poorer classification statistics when applying the suggested cutoff score to Black participants compared to White participants. The purpose of this study is to examine the influence of race on MoCA classification and to establish suggested MoCA cutoff scores based upon a larger representative patient group compared to previous studies. Even with the logistical regression-based norms, Black and Hispanic participants generally scored lower on the MoCA compared to White participants, suggesting diversity influence in MoCA performance and the need for appropriately derived cutoff scores rather than a universal cutoff score. When using the suggested cutoff score of ≤26/30, 61.4% of their 5,338 total participants were classified as having MCI. (2021) also explored the discrimination of using a cutoff score suggested by Carson et al.’s (2018) meta-analysis and observed that a cutoff score of 23/30 classified 29.2% of participants with MCI. (2021) developed robust demographically-adjusted normative data for White, Black, and Hispanic participants. While racial differences have been reported, Sachs et al. If the suggested cutoff score of ≤26/30 had been used in any of these samples, it would have resulted in higher rates of misdiagnosis of MCI. However, the small sample sizes may limit the generalizability of these findings for Black persons ( Goldstein et al., 2014, n = 81 Milani et al., 2018, N = 3,895, and Rossetti et al., 2019, n = 135). (2019) suggested a cutoff score of ≤24/30. (2018) reported ≤25/30 as the optimal cutoff score in a sample of non-Hispanic White, ≤23/30 non-Hispanic Black, and ≤24/30 Hispanic persons, and Rossetti et al. (2014) suggested a cutoff score of ≤24/30 to be more appropriate for Black persons with MCI, Milani et al. (2019) observed that non-Hispanic Black persons’ risk for underdiagnosed dementia were nearly doubled compared to non-Hispanic White persons. Racial and ethnic demographics are important influences on MoCA performance levels, as measurement bias may inflate rates of cognitive impairment among historically underserved and marginalized populations ( Gianattasio et al., 2019 Milani et al., 2018). Consequently, a range of cutoffs from ≤23/30 to ≤27/30 across national and international samples to indicate abnormal cognitive functioning have been suggested ( Carson et al., 2018 Ng et al., 2013). Although many international studies exist to characterize classification accuracy in different languages and cultures, (e.g., Bosco et al., 2017 Freitas et al., 2013 Memória et al., 2013 Ng et al., 2013 Tsai et al., 2012 Zhou et al., 2015), few studies in North America have formally explored cutoff scores with population-based scores, and even fewer have explored possible differences across racial and ethnic minorities. Therefore, the loss in sensitivity can lead to an increased number of false negatives.ĭifferent cutoff scores based on population, age, race, ethnicity, and level of education have been proposed (Cecato et al., 2016 Jeffers, 2019 Milani et al., 2018). (2013) reported a decrease in sensitivity, from 80% to 69%, when applying the education correction but with a small increase in specificity, from 89% to 92%. However, this one-point correction may adversely affect reliability in community and hospital-based samples ( Bernstein et al., 2011 Gagnon et al., 2013 Ng et al., 2013). The standard scoring adds a one-point correction for individuals with 12 or fewer years of education ( McPherson & Koltai, 2018 Rossetti et al., 2011). The initial validation study resulted in a suggested cutoff score of 26/30, where scores less than 26/30 suggest cognitive impairment ( McPherson & Koltai, 2018 Nasreddine et al., 2005 Rossetti et al., 2011). The Montreal Cognitive Assessment (MoCA) is a commonly used cognitive screening test to detect mild cognitive impairment (MCI).
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