Validity and reliability of two alternate versions of the Montreal Cognitive Assessment (Hong Kong version) for screening of Mild Neurocognitive Disorder

Adrian Wong; Stanley Yiu; Ziad Nasreddine; Kam-Tat Leung; Alexander Lau; Yannie O Y Soo; Lawrence Ka-Sing Wong; Vincent Mok

doi:10.1371/journal.pone.0196344

Validity and reliability of two alternate versions of the Montreal Cognitive Assessment (Hong Kong version) for screening of Mild Neurocognitive Disorder

PLoS One. 2018 May 23;13(5):e0196344. doi: 10.1371/journal.pone.0196344. eCollection 2018.

Authors

Adrian Wong^{1

2}, Stanley Yiu¹, Ziad Nasreddine³, Kam-Tat Leung¹, Alexander Lau¹, Yannie O Y Soo¹, Lawrence Ka-Sing Wong¹, Vincent Mok^{1

2

4}

Affiliations

¹ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
² Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong SAR, China.
³ Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Canada.
⁴ Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.

Abstract

Objective: Repeated testing using the Montreal Cognitive Assessment (MoCA) increases risks for practice effects which may bias measurements of cognitive change. The objective of this study is to develop two alternate versions of the MoCA (Hong Kong version; HK-MoCA) and to investigate the validity and reliability of the alternate versions in patients with DSM-5 Mild Neurocognitive Disorder (Mild NCD) and cognitively healthy controls.

Methods: Concurrent validity and inter-scale agreement were examined by Pearson correlation of the total scores between the original and alternate versions and the Bland-Altman Method. Criterion validity of the two alternate versions in differentiating patients with Mild NCD was tested using receiver operating characteristic curve (ROC) analysis. One-month test-retest and inter-rater reliability were examined in 20 participants. Internal consistency of the alternate versions was measured by the Cronbach's α.

Results: 30 controls (age 73.4 [4.5] years, 60% female) and 30 patients (age 75.4 [5.5] years, 73% female) with Mild NCD were recruited. Both alternate versions significantly correlated with the original version (r = 0.79-0.87, p<0.001). Mean differences of 0.17 and -0.40 points were found between the total scores of the alternate with the original versions with a consistent level of agreement observed throughout the range of cognitive abilities. Both alternate versions significantly differentiated patients with Mild NCD from healthy controls (area under ROC 0.922 and 0.724, p<0.001) and showed good one-month test-retest reliability (intra-class correlation [ICC] = 0.92 and 0.82) and inter-rater reliability (ICC = 0.99 and 0.87) and high internal consistency (Cronbach α = 0.79 and 0.75).

Conclusion: The two alternate versions of the HK-MoCA are useful for Mild NCD screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Case-Control Studies
Cognitive Dysfunction / diagnosis*
Female
Hong Kong
Humans
Male
Mental Status and Dementia Tests* / statistics & numerical data
ROC Curve
Reproducibility of Results

Grants and funding

This study was supported by the Chinese University of Hong Kong Direct Grant for Research (2014.2.020) to Adrian Wong, Health and Health Services Research Fund (06070231) to Vincent Mok, and General Research Fund of Research Grant Council (471911) to Vincent Mok. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.