Importance of Using Baseline Verbal Abilities When interpreting the MOCA Test Performance

The Montreal Cognitive Assessment (MOCA) is widely used as a mental status screening test to detect cognitive impairment in adults. One point is given to individuals with 12 or lower years of education. However, studies suggest the one-point adjustment may not be sufficient to address the impact of low education on test performance (Malek-Ahmadi et al., 2015). The aim of this study is to compare the effects of educational achievement versus baseline verbal abilities on MOCA performance. Fifty patients with cognitive concerns were referred to Massachusetts General Brigham for neuropsychological evaluations. Measures of literacy were used to estimate baseline verbal abilities. Educational achievement was based on self-report. Performance on literacy measures predicted the MOCA performance, R2=.041, F(3,139)= 9.172, p<.001. Years of education correlated with measures of literacy, r(44)=.494, p< .001, but not with the MOCA performance. Findings suggest that education-adjusted scoring on the MOCA may not be sufficient to “level the playing field” in terms of MOCA performance. It may be the case that literacy has a more robust effect on MOCA performance due to the inherent verbal nature of the MOCA. Current data highlights the importance of considering a patient’s baseline verbal abilities in the interpretation of the MOCA.