![]() In spite of an ongoing emphasis on optimizing the recruitment of Hispanic participants for dementia research, there is still a dearth of research on the utility of the MoCA in Spanish speakers. In order to improve our ability to detect the earliest cognitive changes in this ethnic group, a more thorough understanding of the testing behavior of screening instruments in these populations is required. According to the Alzheimer's Association's 2013 ‘Alzheimer's disease facts and figures' report, older Hispanics are about 1.5 times as likely to have Alzheimer's disease (AD) and other dementias compared to older Caucasians but less likely than older Caucasians to have a diagnosis. Hispanics living in the US represent a heterogeneous group, consisting of people of diverse linguistic and cultural traditions from the Caribbean, South America, Central America, and Mexico. By 2020, 20% of the elderly population in California will be Hispanic. ![]() Hispanics are the most rapidly growing group in the US. The MoCA has been translated into approximately 37 languages (available at ). ![]() The use of cognitive instruments in minorities or other populations outside the group in which it was originally developed can require linguistic translation and often also cultural adaptation. For example, studies carried out in the US, China, and Colombia all reported educational effects on MoCA performance which may not be fully compensated by the suggested score adjustments. Score adjustments based on relatively homogeneous populations such as these can be sample specific and may not be generalizable to populations with diverse cultural, linguistic, and socioeconomic backgrounds. No score adjustment was suggested for those with <4 years of education. More recently, in recognition of the necessity for further score correction in individuals with a lower education, the same group recommended a revised correction of +1 point for 10-12 years of education and +2 points for 4-9 years of education. , was derived from a validation sample residing in Montreal with a mean educational level of approximately 12 years. The initial 1-point correction for ≤12 years of education, suggested by Nasreddine et al. Performance on the MoCA has been demonstrated to be dependent on the educational level. The Montreal Cognitive Assessment (MoCA) is a 10- to 20-min screening test designed to assist clinicians in detecting early or minor cognitive impairment. Overall, the Spanish version of the MoCA maintained adequate psychometric properties in this population. Conclusion: A compensation of 3-4 points was needed for <6 years of education. Cube copying, sentence repetition, delayed recall, and orientation were most sensitive to cognitive impairment due to AD. 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. The interval reliability of the MoCA as well as item discrimination and item validity were examined. Sensitivity and specificity analyses were performed for the raw and each adjusted score. We examined the pattern of diagnosis-adjusted MoCA residuals in relation to education and compared four alternative score adjustments using bootstrap sampling. Methods: We analyzed data from 50 Spanish-speaking participants. 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. For more information about the MCAT exam, visit Performance on the Montreal Cognitive Assessment (MoCA) has been demonstrated to be dependent on the educational level. The content is also included in the Pre-health Collection within MedEdPORTAL’s iCollaborative sponsored by the AAMC: *MCAT® is a program of the AAMC and related trademarks owned by the Association include Medical College Admission Test, MCAT, and MCAT2015. These videos, questions, and articles are available under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 United States License (available at ). All materials are categorized according to the pre-health competencies tested by the new MCAT exam however, the content in this collection is not intended to prescribe a program of study for the new MCAT exam. All content in this collection has been created under the direction of the Khan Academy and has been reviewed under the direction of the AAMC (Association of American Medical Colleges). Content will be added to the collection through 2015. The collection contains more than 1000 videos and 2800 practice questions. MCAT This collection is being developed for the revised MCAT® exam that will first be administered in April 2015.
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