Is the Montreal cognitive assessment culturally valid in a diverse geriatric primary care setting? Lessons from the Bronx.
Is the Montreal cognitive assessment culturally valid in a diverse geriatric primary care setting? Lessons from the Bronx.
复制标题
蒙特利尔认知评估在多元化的老年初级保健环境中在文化上有效吗？
DOI：
10.1111/jgs.18705
复制
发表时间：
2024
影响因子：
6.3
通讯作者：
Weiss,EricaF
中科院分区：
文献类型：
--
作者：
Stimmel,MarninaB;Orkaby,ArielaR;Ayers,Emmeline;Verghese,Joe;Nsubayi,CelesteK;Weiss,EricaF
背景MoCA在不同种族文化和语言背景下进行认知筛查的有效性和有效性尚不清楚。我们试图检验西班牙语和英语MoCA版本的效用和判别效度，以识别不同社区居住的老年人的认知障碍。方法招募年龄≥65岁，在纽约州布朗克斯接受初级门诊治疗的认知问题患者。MoCA和神经心理学测量用西班牙语或英语进行，神经心理学家确定认知状态（正常但主观认知问题[SCC]，轻度认知障碍[MCI]和痴呆）。单因素方差分析比较认知状态。ROC分析确定了辨别可能的认知障碍的最佳MoCA切点。结果231名参与者，平均年龄73岁，女性72%，西班牙裔43%；39%黑人/非裔美国人；113人（49%）完成了英语测试，118人（51%）完成了西班牙语测试。总体MoCA平均值为17.7 （SD = 4.3）。神经心理学评估确定90例为认知正常/SCC，平均MoCA为19.9 (SD = 4.1)， 133例为MCI，平均MoCA为16.6 (SD = 3.7)， 8例为痴呆，平均MoCA为10.6 （SD = 3.1）。英语MoCA平均值为18.6 (SD = 4.1)，西班牙语为16.7 （SD = 4.3）。公布的MCI临界值≤23产生了高假阳性率（79%）。ROC分析确定，在有认知问题的老年人样本中，使用英语MoCA识别MCI或痴呆的评分≤18.5分（65%敏感性，77%特异性），西班牙语MoCA识别MCI或痴呆的评分≤16.5分（64%敏感性，73%特异性）。结论：在文化/语言多样化的城市环境中，目前的MoCA切点过高，导致高假阳性率。较低的西班牙语和英语MoCA切点可能提高识别这一群体认知障碍的诊断准确性，强调需要为种族文化和语言多样化的老年人创建和验证准确的认知筛查。
BackgroundEfficacy and validity of the MoCA for cognitive screening in ethnoculturally and linguistically diverse settings is unclear. We sought to examine the utility and discriminative validity of the Spanish and English MoCA versions to identify cognitive impairment among diverse community‐dwelling older adults.MethodsParticipants aged ≥65 with cognitive concerns attending outpatient primary care in Bronx, NY, were recruited. MoCA and neuropsychological measures were administered in Spanish or English, and a neuropsychologist determined cognitive status (normal with subjective cognitive concerns [SCC], mild cognitive impairment [MCI], and dementia). One‐way ANOVA compared cognitive statuses. ROC analyses identified optimal MoCA cutpoints for discriminating possible cognitive impairment.ResultsThere were 231 participants, with mean age 73, 72% women, 43% Hispanic; 39% Black/African American; 113 (49%) completed testing in English and 118 (51%) in Spanish. Overall MoCA mean was 17.7 (SD = 4.3). Neuropsychological assessment identified 90 as cognitively normal/SCC, average MoCA 19.9 (SD = 4.1), 133 with MCI, average MoCA 16.6 (SD = 3.7), and 8 with dementia, average MoCA 10.6 (SD = 3.1). Mean English MoCA average was 18.6 (SD = 4.1) versus Spanish 16.7 (SD = 4.3). The published cutpoint ≤23 for MCI yielded a high false‐positive rate (79%). ROC analyses identified ≤18.5 as the score to identify MCI or dementia using the English MoCA (65% sensitivity; 77% specificity) and ≤16.5 for the Spanish MoCA (64% sensitivity;73% specificity) in this sample of older adults with cognitive concerns.ConclusionsCurrent MoCA cutpoints were inappropriately high in a culturally/linguistically diverse urban setting, leading to a high false‐positive rate. Lower Spanish and English MoCA cutpoints may improve diagnostic accuracy for identifying cognitive impairment in this group, highlighting the need for the creation and validation of accurate cognitive screeners for ethnoculturally and linguistically diverse older adults.