The Influence of Education on Chinese Version of Montreal Cognitive Assessment in Detecting Amnesic Mild Cognitive Impairment among Older People in a Beijing Rural Community

To assess the influence of education on the performance of Chinese version of Montreal cognitive assessment (C-MoCA) in relation to the mini-mental state examination (MMSE) in detecting amnesic mild cognitive impairment (aMCI) among rural-dwelling older people C-MoCA and MMSE was administered and diagnostic interviews were conducted among community-dwelling elderly in two villages in Beijing. The performance of C-MoCA and MMSE in detecting aMCI was evaluated by the area under the ROC curve (AUC). Effect size of education on variations in C-MoCA scores was estimated with general linear model. Among 172 study participants (24 cases of aMCI and 148 normal controls), the AUC of C-MoCA was 0.72 (95% CI = 0.62-0.81, cutoff = 20/21), compared to AUC of MMSE of 0.74 (95% CI = 0.64-0.84, cutoff = 26/27). The performance of both C-MoCA and MMSE was especially poorer among those with low (0-6 years) education. After controlling for gender and age, education ( η(2) = 0.204) had a surpassing effect over aMCI diagnosis ( η(2) = 0.052) on variations in C-MoCA scores. Among rural older people, the MoCA showed modest accuracy and was no better than MMSE in detecting aMCI, especially in those with low education, due to the overwhelming effect of education relative to aMCI diagnosis on variations in C-MoCA performance.