Sains Malaysiana 45(9)(2016): 1337–1343

Validation and Optimal Cut-Off Scores of the Bahasa Malaysia Version of the Montreal Cognitive Assessment (MoCA-BM) for Mild Cognitive Impairment among Community Dwelling Older Adults in Malaysia

(Keesahan dan Skor Titik Potong Optimum Versi Bahasa Malaysia Penilaian Kognitif Montreal (MoCA-BM) untuk Kecelaan Kognitif Ringan dalam Kalangan Komuniti Rumah Warga Tua

di Malaysia)

NORMAH CHE DIN^1*, SUZANA SHAHAR², BAITIL HUSNA ZULKIFLI¹, ROSDINOM RAZALI³, CHYN AI VYRN⁴ & AZHADI OMAR⁵

¹Health Psychology Programme, School of Healthcare Sciences, Faculty of Health Sciences

Universiti Kebangsaan Malaysia, Jalan Raja Muda Abd Aziz, 50300 Kuala Lumpur, Federal Territory, Malaysia

²Dietetic Programme, Centre of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Federal Territory

Malaysia

³Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Federal Territory, Malaysia

⁴Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Federal Territory, Malaysia

⁵Institute for Public Health, Jalan Bangsar, Federal Hill, 50590 Kuala Lumpur, Federal Territory

Malaysia

Received: 26 October 2015/Accepted: 25 April 2016

ABSTRACT

The goal of this study was to examine the reliability and validity of the Bahasa Malaysia version of the Montreal cognitive assessment (MoCA-BM) and to determine its optimal cut-off score among older adults with mild cognitive impairment (MCI), after adjustments for age, gender, levels of education, physical functioning and depressive symptoms. A total of 2237 community dwelling older adults aged 60 years and above were randomly selected for the study, excluding those with MMSE score below 14. Instruments administered were the MoCA-BM, the Malay Mini-Mental State Examination (MMMSE), the Rey Auditory Verbal Learning Test (RAVLT), the Digit Span and the Digit Symbol subtests of the Wechsler Adult Intelligence Scale (WAIS), activities of daily living (ADL) and the Geriatric Depression Scale (GDS). MCI were determined using the Petersen’s 2014 criteria as the gold standard. SPSS version 22 was used for reliability and validity analysis and optimal cut-off score detection. Cronbach’s α of the MoCA-BM was 0.691 and concurrent validity was high between MoCA-BM and MMMSE scores (r=0.741). Optimal cut-off point for MoCA-BM to detect MCI among older adults in Malaysia was 17/18, with sensitivity of 68.2% and specificity of 61.3%. Using this cut-off, 38.9% of participants were detected to be at risk of MCI. In conclusion, MoCA-BM is a reliable and valid screening instrument for MCI among Malaysian elderly community. The newly derived optimal cut-off for MCI is much lower than the original MoCA with modest ability to discriminate between normal and MCI older adults in the community.

Keywords: Mild cognitive impairment; Mini Mental Status Examination; Montreal Cognitive Assessment; older adults; validation

ABSTRAK

Matlamat kajian ini adalah untuk mengkaji kebolehpercayaan dan keesahan Penilaian Kognitif Montreal (MoCA-BM) versi Bahasa Malaysia dan untuk menentukan skor titik potong optimum dalam kalangan warga tua yang mempunyai kecelaan kognitif ringan (MCI) selepas dilakukan penyesuaian untuk umur, jantina, tahap pendidikan, kefungsian fizikal dan simptom kemurungan. Sejumlah 2237 warga tua yang tinggal dalam komuniti rumah berumur 60 tahun ke atas telah dipilih secara rawak untuk kajian ini kecuali mereka yang mempunyai skor MMSE 14 ke bawah. Instrumen yang digunakan adalah MoCA-BM, Pemeriksaan Keadaan Mental Mini Bahasa Malaysia (MMMSE), Ujian Pembelajaran Lisan Pendengaran Rey (RAVLT), sub ujian Digit Span dan Digit Simbol dari Skala Kecerdasan Dewasa Wechsler (WAIS), Aktiviti Hidup Seharian (ADL) dan Skala Kekecewaan Geriatrik (GDS). MCI ditentukan menggunakan kriteria Petersen 2014 sebagai piawai emas. SPSS versi 22 telah digunakan untuk analisis kebolehpercayaan dan keesahan dan penentuan skor titik potong optimum. α Cronbach untuk MoCA-BM adalah 0.691 dan keesahan serentak adalah tinggi antara MoCA-BM dan skor MMMSE (r=0.741). Titik potong optimum MoCA-BM untuk menentukan MCI dalam kalangan warga tua di Malaysia adalah 17/18, dengan kepekaan 68.2% dan kekhususan 61.3%. Menggunakan titik potong ini, 38.9% peserta dikenal pasti mempunyai risiko MCI. Kesimpulannya, MoCA-BM adalah satu instrumen saringan MCI yang boleh dipercayai dan sah dalam kalangan komuniti warga tua Malaysia. Titik potong yang baru diperoleh untuk MCI adalah lebih rendah berbanding MoCA asal dengan kebolehan sederhana untuk membezakan antara warga tua yang normal dan warga tua MCI dalam komuniti.

Kata kunci: Kecelaan kognitif ringan; keesahan; Penilaian Kognitif Montreal; status pemeriksaan mental mini; warga tua

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*Corresponding author; email: normah@fsk.ukm.my