Brazil is a country with continental dimensions, with a considerable socieodemographic and cultural regional variety, which could influence the performance of the elderly on the MoCA-BR. Another limitation is that the participants were recruited from one city in Brazil. Therefore, application of the results of this study to elderly people who have less than 4 years of education is not recommended. Moreover, the original MoCA study was developed for cognitive screening of people with a minimum formal education of 4 years. The use of the MoCA in this group would lead to a loss of discriminating power between normal and pathological, with an increase in false positives and false negatives, as occurred in studies which included illiterate or poorly educated older people. The MoCA presents items that are inadequate for individuals with little or no formal education (especially the items related to executive functions). Participants with less than 4 years of education were excluded. The present study has limitations that should be addressed. People with fewer than 21 points must be referred for follow-up and a clear diagnosis. With the recommendation that 1 point be added to the MoCA-BR score obtained for participants with up to 12 years of education – similar to that recommended by the MoCA author – the cutoff point suggested in the present study is 20/21 to discriminate between the cognitively healthy individuals and those with mild cognition impairment. , from values similar to those in the present study to a cutoff point of 14/15 in a study conducted in Spain with elderly people in the control and AD groups with an average education less than that of those in present study. Other studies that used other versions of the MoCA also proposed cutoff scores inferior to those proposed by Nasreddine et al. This shows the importance of adapting the cutoff point according to the population under study. The excellent accuracy of the MoCA-BR when using the cutoff scores proposed in the present study was in contrast with the low percentage of correct classifications when using the cutoff point proposed by the author of the MoCA (62.4%), which is compatible with the results found in a recent meta-analysis. In turn, the diagnosis of AD was based on the criteria of the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer’s Disease and Related Disorders Association (NINCDS/ADRA). The MCI diagnosis was defined based on the criteria of Petersen.

The occupational therapist who applied the MoCA-BR did not participate in the consensus meeting for selection and classification of the elderly, in an effort to avoid the risk of bias by using the information on the MoCA-BR performance for the definition of a cognitive diagnosis. The exclusion criteria for the AD group were: a diagnosis of mixed dementia (AD associated with another type of dementia), and moderate or advanced stages of dementia evaluated by CDR.Ĭonsidering the inclusion and exclusion criteria in the medical interview, past and current medical histories of the elderly, and the performance of a complete neuropsychological evaluation performed by an experience professional, a team composed of a psychiatrist, a neuropsychologist, and a geriatric doctor classified, following a consensus meeting, the participants selected for the control group, the MCI group, and the AD CDR 1 group. The inclusion criteria for the AD group were: age ≥65 years education ≥4 years a clinical diagnosis of Alzheimer’s disease (AD), supported by neuropsychological tests showing cognitive impairment and a functional evaluation showing a decrease in functionality and mild stage dementia, evaluated through CDR, corresponding to a score equal to 1 using this tool. The exclusion criterion for the MCI group was a diagnosis of dementia. The inclusion criteria of the MCI group were: age ≥65 years education ≥4 years a subjective cognitive complaint, preferably confirmed by an informant an objective cognitive deficit confirmed by a low performance under the level expected on neuropsychological tests normal general cognitive functions and intact or minimally impaired functional activities. The exclusion criteria for the control group were: a diagnosis of dementia a diagnosis of relevant neurological or psychiatric diseases or systematic uncontrolled chronic diseases that have an impact on cognition a history of alcoholism or substance abuse aphasia or a visual, hearing, or motor handicap evidence of loss of autonomy or independence in daily activities regular use of psychotropic drugs and altered performance on neuropsychological tests. The inclusion criteria for the control group were: age ≥65 years and education ≥4 years.

Moca scoring cutoffs