![]() ![]() found that this score was better at predicting cognitive decline in mild cognitive impairment than the total score. In an effort to more effectively distinguish impairments in memory encoding from retrieval, the Memory Index Score (MIS) has been developed, which incorporates performance on these additional cued recall and recognition trials. Īs currently constructed, the MoCA’s Delayed Recall score (DR) only awards points for spontaneous recall, resulting in a metric that is limited by a restricted range (0–5) and an inability to distinguish between deficits in encoding from deficits in retrieval, even though cued recall and recognition trials can be administered. Only one prior study has investigated the ability of MoCA to identify different memory profiles, finding good utility in its ability to distinguish AD from Huntington’sdisease. Despite widespread use, there has been relatively little research into the neuroanatomical correlates associated with memory performance on the MoCA. Previous work assessing the association between hippocampal volumes and individual memory processes using standard neuropsychological measures has found robust associations with estimates of both learning and recall, as well as, recognition of previously learned material. This memory profile, commonly described as “amnestic type” memory loss, distinguishes AD from other dementia syndromes such as Lewy body disease and vascular cognitive impairment, in which recognition memory typically exceeds free recall (i.e., memory performance improves with cues). On cognitive testing this manifests as poor recall of previously learned information with little or no benefit from retrieval cues. AD is commonly associated with atrophy of the hippocampus and related mesial temporal structures that are critical for encoding new information. Of particular relevance in distinguishing AD from other dementia syndromes is the memory profile. An advantage of the MoCA over other screening tests is that performance can be deconstructed into cognitive domains, providing a more granular view of an individual’s cognition that may be used to inform the initial diagnostic considerations of patients presenting with cognitive complaints. Moreover, we described a systematic approach for adjusting the effects of age and education using fractional polynomials and provided suggestions on how to account for the nonlinear relationship that is frequently encountered between demographic factors and measures of cognitive performance.The Montreal Cognitive Assessment (MoCA) is a widely-used screening tool for cognitive impairment in Alzheimer’s disease (AD) and other forms of dementia. ConclusionsWe presented normative data for the MoCA and the MoCA-MIS that will facilitate the use of the test in Brazil and, potentially, in other populations with substantial proportions of low-educated individuals. On the other hand, MoCA-MIS scores presented a nonlinear negative relationship with age, with an accelerated pattern at higher age levels (P<0.001). MoCA scores presented a nonlinear positive association with education tending to a plateau at higher levels (P<0.001). These data reinforce the need of adjusting cutoffs for schooling in populations with heterogeneous educational backgrounds. Even using a more conservative suggestion (22 points), 67% of our normative sample would be regarded as impaired. ResultsAccording to the original proposed cutoff (25 points), 87% of our sample would be considered impaired. To account for nonlinear relationships, we have used fractional polynomials that provide a flexible parameterization for continuous variables. The final sample consisted of 597 cognitively healthy Brazilians aged 50 to 90years. Dementia has been excluded with the Functional Activities Questionnaire. MethodsCommunity-dwelling outpatients were enrolled if they had no history of neurologic or psychiatric diseases and were not taking any drugs with effects on the central nervous system. ![]() ObjectiveTo provide age-corrected and education-corrected norms for the Montreal Cognitive Assessment (MoCA) and the Memory Index Score (MoCA-MIS) in Brazil. INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, v.33, n.7, p.893-899, 2018 Normative data for the Montreal Cognitive Assessment (MoCA) and the Memory Index Score (MoCA-MIS) in Brazil: Adjusting the nonlinear effects of education with fractional polynomialsĪPOLINARIO, Daniel SANTOS, Marilia Funchal dos SASSAKI, Eduardo PEGORARO, Fernanda PEDRINI, Anna Vitoria Alves CESTARI, Bruna AMARAL, Ana Helena MITT, Mayra MUELLER, Marina Bellatti SUEMOTO, Claudia Kimie APRAHAMIAN, Ivan Please use this identifier to cite or link to this item: ![]()
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