For example, all the hearing-dependent questions that were deleted in the MoCA-H 4 relate to memory. First, deleting hearing-dependent or vision-dependent items is liable to compromise the validity of the MoCA, because deletion may lead to particular cognitive domains being under-represented or unrepresented. There are several drawbacks with previous adaptations of the MoCA for sensory impaired populations. There was no significant difference in MoCA-Blind scores between those with normal vision and those with vision impairment. Wittich et al 3 reported that the MoCA-Blind (involving deletion of four vision-dependent items trail-making, copy-cube, clock drawing and picture naming) had increased specificity compared with standard MoCA, but sensitivity was poorer for both MCI and AD (63% and 94%, respectively).ĭupuis et al 4 examined performance of the MoCA-Blind on the performance of participants with normal vision (n=259) versus those with vision impairment (based on far acuity poorer than
The MoCA has previously been validated in populations with vascular dementia, frontotemporal dementia, 12 Parkinson’s disease 13 and Alzheimer’s disease (AD) 14 and has good sensitivity and specificity for the detection of both dementia and mild cognitive impairment (MCI). Administration time is usually less than 20 min. The MoCA consists of a single page, 30-item test that measures abilities in eight domains: visuospatial/executive, naming, memory, attention, language, abstraction, delayed recall and orientation.
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11 The MoCA is a widely used screening measure that is available free of charge and has been translated into 55 different languages. To address the need for reliable screening measures of cognitive function for people with acquired sensory impairment, we propose to develop and validate versions of the Montreal Cognitive Assessment (MoCA). 10 Unfortunately, deletion of hearing-dependent or vision-dependent items may adversely impact sensitivity and specificity of the adapted tests. Previous attempts to adapt cognitive tests for people with sensory impairment involved deleting or substituting written versions of hearing-dependent items and deleting or substituting spoken or tactile versions of vision-dependent items. In two UK studies, hearing impairment was identified in 94% of people with a cognitive impairment attending a memory clinic 8 and a national survey identified visual impairment (visual acuity worse than 6/12) in 32.5% of a sample of people with dementia. 7 Hearing and vision impairment commonly co-occur with cognitive impairment in older adults. 1–6 The confounding of cognitive tests by hearing or vision impairment may lead to false positive identification of cognitive impairment and/or over-estimation of the severity of cognitive impairment. People with hearing or visual impairment and simulated hearing or vision impairment perform more poorly on tests of cognition than those with normal sensory function.
Commonly used tests for cognitive impairment mostly consist of items presented in the visual and/or auditory modality and rely on good sensory function.
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