Use of the MoCA in detecting early alzheimer's disease in a spanish-speaking population with varied levels of education

Yan Zhou, Freddy Ortiz, Christopher Nuñez, David Elashoff, Ellen Woo, Liana G. Apostolova, Sheldon Wolf, Maria Casado, Nenette Caceres, Hemali Panchal, John M. Ringman

Research output: Contribution to journalArticle

17 Scopus citations


Background/Aims: Performance on the Montreal Cognitive Assessment (MoCA) has been demonstrated to be dependent on the educational level. The purpose of this study was to identify how to best adjust MoCA scores and to identify MoCA items most sensitive to cognitive decline in incipient Alzheimer's disease (AD) in a Spanish-speaking population with varied levels of education. Methods: We analyzed data from 50 Spanish-speaking participants. We examined the pattern of diagnosis-adjusted MoCA residuals in relation to education and compared four alternative score adjustments using bootstrap sampling. Sensitivity and specificity analyses were performed for the raw and each adjusted score. The interval reliability of the MoCA as well as item discrimination and item validity were examined. Results: We found that with progressive compensation added for those with lower education, unexplained residuals decreased and education-residual association moved to zero, suggesting that more compensation was necessary to better adjust MoCA scores in those with a lower educational level. Cube copying, sentence repetition, delayed recall, and orientation were most sensitive to cognitive impairment due to AD. Conclusion: A compensation of 3-4 points was needed for <6 years of education. Overall, the Spanish version of the MoCA maintained adequate psychometric properties in this population.

Original languageEnglish (US)
Pages (from-to)85-95
Number of pages11
JournalDementia and Geriatric Cognitive Disorders Extra
Issue number1
StatePublished - Jan 1 2015



  • Alzheimer's disease
  • Dementia
  • Education
  • Hispanic population
  • Latino population
  • Mild cognitive impairment
  • Montreal cognitive assessment
  • Screening
  • Spanish-speaking population

ASJC Scopus subject areas

  • Cognitive Neuroscience
  • Psychiatry and Mental health

Cite this

Zhou, Y., Ortiz, F., Nuñez, C., Elashoff, D., Woo, E., Apostolova, L. G., Wolf, S., Casado, M., Caceres, N., Panchal, H., & Ringman, J. M. (2015). Use of the MoCA in detecting early alzheimer's disease in a spanish-speaking population with varied levels of education. Dementia and Geriatric Cognitive Disorders Extra, 5(1), 85-95.