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Evaluation of a Brief Survey Instrument for Assessing Subtle Differences in Cognitive Function Among Older Adults

Kotwal, Ashwin A. MD, MS*,†; Schumm, Philip MA; Kern, David W. MA; McClintock, Martha K. PhD; Waite, Linda J. PhD§; Shega, Joseph W. MD*; Huisingh-Scheetz, Megan J. MD*; Dale, William MD, PhD*

Alzheimer Disease & Associated Disorders: October-December 2015 - Volume 29 - Issue 4 - p 317–324
doi: 10.1097/WAD.0000000000000068
Original Articles

Most measures of cognitive function used in large-scale surveys of older adults have limited ability to detect subtle differences across cognitive domains, and standard clinical instruments are impractical to administer in general surveys. The Montreal Cognitive Assessment (MoCA) can address this need, but has limitations in a survey context. Therefore, we developed a survey adaptation of the MoCA, called the MoCA-SA, and describe its psychometric properties in a large national survey. Using a pretest sample of older adults (n=120), we reduced MoCA administration time by 26%, developed a model to accurately estimate full MoCA scores from the MoCA-SA, and tested the model in an independent clinical sample (n=93). The validated 18-item MoCA-SA was then administered to community-dwelling adults aged 62 to 91 as part of the National Social life Health and Aging Project Wave 2 sample (n=3196). In National Social life Health and Aging Project Wave 2, the MoCA-SA had good internal reliability (Cronbach α=0.76). Using item-response models, survey-adapted items captured a broad range of cognitive abilities and functioned similarly across sex, education, and ethnic groups. Results demonstrate that the MoCA-SA can be administered reliably in a survey setting while preserving sensitivity to a broad range of cognitive abilities and similar performance across demographic subgroups.

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Departments of *Medicine, Section of Geriatrics and Palliative Medicine

Health Studies

Comparative Human Development and Institute for Mind and Biology

§Sociology, University of Chicago, Chicago, IL

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Supported by Clinical and Translational Science Award (CTSA) TL1 predoctoral training grant; National Social Life Health and Aging Project (NSHAP) (NIH-5R01 AG021487); National Social Life, Health, and Aging (NSHAP)—Partners R01AG033903. Also supported by funding for MERIT Award R37AG030481 from the National Institute on Aging and the National Institutes of Health, including the National Institute on Aging, the Office of Women’s Health Research, the Office of AIDS Research, the Office of Behavioral and Social Sciences Research, and the National Institute on Child Health and Human Development for the National Health, Social Life, and Aging Project (NSHAP R01AG021487, R37AG030481), and the NSHAP Wave 2 Partner Project (R01AG033903).

The authors declare no conflicts of interest.

Reprints: Ashwin A. Kotwal, MD, MS, Department of Medicine, Section of Geriatrics & Palliative Medicine, University of Chicago Medicine, MC6098, 5841 S. Maryland Avenue, Chicago, IL 60637 (e-mail:

Received May 24, 2014

Accepted October 7, 2014

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