BACKGROUND The Montreal Cognitive Assessment (MoCA) is widely used to evaluate cognitive decline in older individuals. Although, age and education-related norms have been published, the vast majority of diagnostic clinicians use the MoCA cutoff score to identify patients with cognitive impairment. AIM To identify whether the MoCA cutoff is too stringent for cognitively normal older adults. METHODS Twenty-seven participants aged 68 to 83 (mean = 75.07, standard deviation [SD] = 4.62), with high education level (mean = 17.14 years, SD = 3.21) underwent cognitive assessment once a year for 5 consecutive years. The cognitive assessment included MoCA; Rey Auditory Verbal Learning Test; Rey Osterrieth Complex Figure test; Wechsler Adult Intelligence Scale Information and Digit Span Subtest; Trail Making Test; Verbal Fluency Test; and Beck Depression Inventory questionnaire. Repeated measures analysis of variance (ANOVA) was used to analyze all standardized scores as well as MoCA standardized and raw scores across all years. RESULTS Repeated-measures ANOVA for MoCA raw scores yielded significant decline across the years (P < .05). From the second year and forward, the average MoCA total score was below the cutoff of 26/30. However, in substantial contrast, all other neuropsychological scores and the MoCA standardized scores were within the normal range and even above in all years. CONCLUSION Our study demonstrates that the currently used MoCA cutoff is too high even for highly educated, cognitively normal older adults. Therefore, it is crucial to use the age- and education-related norms for the MoCA in order to avoid misdiagnosis of cognitive decline.

中文翻译：

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MoCA的下限是否太高？受过高等教育的成年人的纵向数据。

背景技术蒙特利尔认知评估（MoCA）被广泛用于评估老年人的认知能力下降。尽管已经发布了与年龄和教育相关的规范，但绝大多数诊断临床医生都使用MoCA截止评分来识别患有认知障碍的患者。目的确定MoCA临界值对于认知正常的成年人是否过于严格。方法27名年龄在68至83岁（平均= 75.07，标准差[SD] = 4.62），文化程度高（平均= 17.14岁，SD = 3.21）的参与者连续5年每年进行一次认知评估。认知评估包括MoCA；雷伊听觉语言学习测试；Rey Osterrieth复杂人物测试；韦克斯勒成人智力量表信息和数字跨度子测验；试行测试；语言能力测试；和贝克抑郁量表问卷。重复测量方差分析（ANOVA）用于分析所有年份的所有标准化评分以及MoCA标准化评分和原始评分。结果多年来，MoCA原始评分的重复测量ANOVA产生了显着下降（P <.05）。从第二年开始，MoCA的平均总分低于26/30的临界值。但是，与之形成鲜明对比的是，所有其他神经心理学得分和MoCA标准化得分均在正常范围内，甚至在所有年份均高于该范围。结论我们的研究表明，即使对于受过良好教育，认知正常的成年人，当前使用的MoCA临界值也太高。因此，对于MoCA使用与年龄和教育相关的规范至关重要，以避免对认知能力下降的误诊。