The Montreal Cognitive Assessment: Norms and Reliable Change Indices for Standard and MoCA-22 Administrations.

OBJECTIVE: The Montreal Cognitive Assessment (MoCA) is among the most frequently administered cognitive screening tests, yet demographically diverse normative data are needed for repeated administrations. METHOD: Data were obtained from 18,410 participants using the National Alzheimer's Coordinating Center Uniform Data Set. We developed regression-based norms using Tobit regression to account for ceiling effects, explored test-retest reliability of total scores and by domain stratified by age and diagnosis with Cronbach's alpha, and reported the cumulative change frequencies for individuals with serial MoCA administrations to gage expected change. RESULTS: Strong ceiling effects and negative skew were observed at the total score, domain, and item levels for the cognitively normal group, and performances became more normally distributed as the degree of cognitive impairment increased. In regression models, years of education was associated with higher MoCA scores, whereas older age, male sex, Black and American Indian or Alaska Native race, and Hispanic ethnicity were associated with lower predicted scores. Temporal stability was adequate and good at the total score level for the cognitively normal and cognitive disorders groups, respectively, but fell short of reliability standards at the domain level. CONCLUSIONS: MoCA total scores are adequately reproducible among those with cognitive diagnoses, but domain scores are unstable. Robust regression-based norms should be used to adjust for demographic performance differences, and the limited reliability, along with the ceiling effects and negative skew, should be considered when interpreting MoCA scores.

Cross-Validating the Executive Errors Scale of the Repeatable Battery for the Assessment of Neuropsychological Status.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was developed to briefly measure a broad range of cognitive abilities, but it initially lacked a scale to evaluate executive functioning. Robert Spencer and colleagues recently created an Executive Errors scale (RBANS-EE) that quantified executive functioning (EF) errors committed during four RBANS subtests: List Learning, Semantic Fluency, Coding, and List Recall. In the present paper we cross-validated the RBANS-EE with a sample of 234 U.S. military veterans (M AGE = 67.2, SD = 11.5 years; M EDUCATION = 13.3, SD = 2.4 years) who completed the RBANS and various EF criterion measures as part of neuropsychological assessments they underwent during their clinical care. We found the RBANS-EE to be significantly correlated with most of the criterion EF measures. The RBANS-EE scale demonstrated modest ability to classify EF impairment at mild and severe levels; and, similarly, the RBANS-EE was modestly capable of accurately classifying those veteran respondents who were determined to have or to not have a neurocognitive disorder. Overall, the RBANS-EE can be quickly calculated, adds no administration time to an RBANS assessment, and yields useful scores to screen for EF dysfunction without replacing standalone EF tests.