The Montreal cognitive assessment - Maltese assessing validity and reliability

Abstract

The aims of this study were to translate the Montreal Cognitive Assessment (MoCA) into Maltese and then validate the Maltese version of the MoCA scale in the screening for mild cognitive impairment (MCI). The Principals of Good Practice outlined by the Translation and Cultural Adaptation Group were used to translate and adapt the MoCA into Maltese. The MoCA-Maltese (MoCA-M) was administered to a sample of 193 persons aged 65 and over from residential and community settings. The sample consisted of 70 persons with MCI and 123 persons with normal cognitive functioning. Performance of the two subgroups' overall performance and subtest performance on the MoCA-M was analysed. Demographic factors and preferred language of use were analysed in light of person's MoCA-M performance. Reliability was assessed through test-retest reliability and inter-rater reliability. Construct validity was assessed by comparing participants' performance on the MoCA-M to the MMSE (Maltese). The tool's sensitivity and specificity were evaluated. Results showed that the MoCA-M was able to discriminate persons with MCI from the controls. Furthermore, nine of the subtests successfully differentiated between persons with MCI and those with no cognitive impairment (NCI). Age was found to be negatively correlated to MoCA-M performance; years of education was found to be positively correlated to MoCA-M performance; married persons obtained significantly better scores than widowed and single persons. Persons who used Maltese and English languages equally for speaking, reading and writing scored significantly better than persons who preferred to use Maltese. Results showed the tool to have good reliability and construct validity. Using a cut-off score of 26 the MoCA-M demonstrated excellent sens A cut-off score of 23 was proposed as it provided the best balance between sensitivity and specificity. The MoCA-M was found to be a valid and reliable instrument which can be used as a brief screening instrument for MCI in Malta.