There are five Chinese versions of the MoCA, including the Beijing version, the Changsha version, the Guangdong version, the Hong Kong version, and the Taiwan version (the specific test forms and instructions for each version are available at the MoCA official website ). Other than the MMSE, the Montreal Cognitive Assessment (MoCA) was specifically developed as a screening tool for MCI and mild dementia, and has been shown to have high sensitivity and specificity for differentiating individuals with MCI from healthy individuals in several developed countries and areas. The Mini-Mental State Examination (MMSE) is the most widely used screening tool for dementia however, it has been demonstrated to be less sensitive to MCI. A brief screening tool would therefore be a more practical approach for frontline clinicians to detect MCI. However, given the cost and time needed, it is often not feasible to use neuroimaging techniques (e.g., MRI, PET, DTI, etc.) or comprehensive neuropsychological tests (e.g., Global Deterioration Scale, GDS, Clinical Dementia Rating, CDR, etc.) in a community setting. In order to improve the diagnostic accuracy of MCI, the use of a combination of neuropsychological assessment batteries, biomarker tests, and neuroimaging techniques was proposed. The diagnosis of and intervention for MCI could be an effective way for early detection and decelerating the progress of dementia among older adults. Recently, researchers have identified a pre-dementia syndrome, mild cognitive impairment (MCI), which is an intermediate clinical state between normal aging and dementia. Early detection of and effective intervention for dementia are crucial. One of these diseases is dementia, which tremendously affects the quality of life of older adults and brings upon a number of related economic and public health issues. It is therefore not surprising that the epidemic of aging-related diseases is also rising rapidly in the country. According to the latest National Population Census, there are approximately 178 million older adults in China up to 2010. Similar to many other developing countries, the aging population has been growing rapidly in China. Further modifications to several test items of the MoCA-BJ are recommended in order to improve the applicability and effectiveness of the MoCA-BJ in MCI screening among the Chinese population. However, presumably due to the linguistic and cultural differences between the original English version and the Chinese version of the scale, and the lower education level of Chinese older adults, the MoCA-BJ is not much better than the MMSE in detecting MCI, at least for this study sample. In general, the MoCA-BJ is an acceptable tool for MCI screening in both urban and rural regions of Beijing. Item analysis showed that the internal consistency was relatively low in both naming and sentence repetition tasks, and the diagnostic accuracy was similar between the MoCA-BJ and the MMSE. Regional differences disappeared when the confounding demographic variables (i.e., age and education) were controlled. Among all the seven cognitive sub-domains, delayed recall was shown to be the best index to differentiate MCI from the normal controls. The MoCA-BJ showed optimal sensitivity (68.7%) and specificity (63.9%) when the cut-off score was lowered to 22. Under the recommended cut-off score of 26, the MoCA-BJ demonstrated an excellent sensitivity of 90.4%, and a fair specificity (31.3%). Demographic and regional differences among our subjects were also taken into consideration. To analyze the effectiveness of the MoCA-BJ, we examined its psychometric properties, conducted item analyses, evaluated the sensitivity and specificity of the scale, and compared the scale with the MMSE. Twenty-one of these participants were diagnosed by experienced psychiatrists as having dementia, 115 participants were diagnosed as MCI, and 865 participants were considered to be cognitively normal. The MoCA-BJ and the Mini-Mental State Examination (MMSE) were administered to 1001 Chinese elderly community dwellers recruited from three different regions (i.e., newly developed, old down-town, and rural areas) in Beijing. A cross-sectional validation study was conducted in several urban and rural communities in Beijing, China, to evaluate the effectiveness of the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) as a screening tool to detect mild cognitive impairment (MCI) among Chinese older adults.
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