Original Research

Montreal Cognitive Assessment test: Psychometric analysis of a South African workplace sample

Charles H. van Wijk, Willem A.J. Meintjes, Chris J.B. Muller
African Journal of Psychological Assessment | Vol 6 | a151 | DOI: https://doi.org/10.4102/ajopa.v6i0.151 | © 2024 Charles H. van Wijk, Willem A.J. Meintjes, Chris J.B. Muller | This work is licensed under CC Attribution 4.0
Submitted: 26 October 2023 | Published: 13 February 2024

About the author(s)

Charles H. van Wijk, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town; and, Institute for Maritime Medicine, Simon's Town, South Africa
Willem A.J. Meintjes, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Chris J.B. Muller, Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa

Abstract

The Montreal Cognitive Assessment (MoCA) test is a widely used tool to screen for mild neurocognitive impairment. However, its structural validity has not been fully described in South Africa. The study aimed to replicate and extend earlier work with South African samples, to provide an expanded description of the psychometric properties of the MoCA. The study examined the MoCA in a sample of neurocognitively healthy working adults (N = 402) and individuals diagnosed with mild neurocognitive disorders (N = 42); both groups reported good English proficiency. Analysis included general scale descriptions, and structural and discriminant validity. Age and language, but not gender, influenced MoCA scores, with mean total scores of healthy individuals falling below the universal cut-off. Structural analysis showed that a multidimensional model with a higher-order general factor fit the data well, and measurement invariance for gender and language was confirmed. Discriminant validity was supported, and receiver operating characteristics curve analysis illustrated the potential for grey-zone lower and upper thresholds to identify risk.

Contribution: This study replicated previous findings on the effects of age, language and gender, and challenged the universal application of ≤ 26 as cut-off for cognitive impairment indiscriminately across groups or contexts. It emphasised the need for context-specific adaptation in cognitive assessments, especially for non-English first language speakers, to enhance practical utility. Novel to this study, it extended knowledge on the structural validity of the test and introduced grey-zone scores as a potential guide to the identification of risk in resource-restricted settings.


Keywords

cognition; dimensionality; grey-zone thresholds; language; measurement invariance; screening; validity

Sustainable Development Goal

Goal 3: Good health and well-being

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