What are the differences between the Hong Kong version of the Montreal Cognitive Assessment (MOCA) and the standard Montreal Cognitive Assessment (MOCA)?

From the Guidelines

The Hong Kong version of the Montreal Cognitive Assessment (MOCA) differs from the standard MOCA in its cultural and linguistic adaptations for Hong Kong's Chinese population, making it a more valid and reliable tool for cognitive assessment in this demographic. The standard MOCA, developed for Western populations, may not accurately account for cultural differences, language considerations, and educational backgrounds specific to Hong Kong residents 1. In contrast, the HK-MOCA maintains the same cognitive domains as the original MOCA, including visuospatial abilities, executive functions, attention, language, memory, and orientation, but uses culturally appropriate items and references that Hong Kong Chinese individuals would be familiar with 1.

Some key differences between the HK-MOCA and the standard MOCA include:

• Culturally adapted items and references to reduce cultural and linguistic biases
• Adjusted scoring thresholds based on local educational norms rather than Western standards
• Accommodations for Chinese linguistic patterns in the language section
• Inclusion of objects commonly recognized in Chinese culture in the naming task

These adaptations make the HK-MOCA a more suitable tool for cognitive assessment in Hong Kong's population, providing more accurate cognitive screening results for this specific demographic 1. The MoCA, including its adapted versions like the HK-MOCA, has been shown to have acceptable diagnostic accuracy for detection of cognitive impairment and is more accurate than the MMSE in detecting mild cognitive impairment (MCI) 1.

Overall, the HK-MOCA is a valuable tool for healthcare professionals in Hong Kong, allowing for more accurate and culturally sensitive cognitive assessments, which is essential for early detection and management of cognitive disorders, ultimately improving patient outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Differences between Hong Kong version of MOCA and standard MOCA

• The Hong Kong version of MOCA (HK-MoCA) is a validated cognitive screening instrument for use in Chinese older adults in Hong Kong 2.
• The HK-MoCA has comparable sensitivity with the Cantonese version of Mini-Mental State Examination for detection of mild cognitive impairment 2.
• A score of less than 22 on the HK-MoCA should prompt further diagnostic assessment 2.
• The standard MOCA has been used as a reference for the development of the HK-MoCA, but the HK-MoCA has been adapted for the Chinese population in Hong Kong 3, 4.
• The HK-MoCA has been shown to be a useful cognitive screening instrument for detecting cognitive impairment in Chinese older adults, with a single cutoff score of 21/22 achieving screening purpose 4.
• Alternate versions of the HK-MoCA have been developed to reduce practice effects and have been shown to be valid and reliable for screening mild neurocognitive disorder 5.
• A version of the HK-MoCA for the visually impaired (HKMoCA-VI) has been proposed, with a suggested cut-off score of 12, yielding a sensitivity and specificity of 89.29% and 83.58%, respectively 6.

Key features of HK-MoCA

• The HK-MoCA is a brief cognitive screening instrument that can be completed in less than 15 minutes 2.
• The HK-MoCA has incorporated essential cognitive domains and is a convenient screening tool to detect cognitive impairment 4.
• The HK-MoCA has been adapted for the Chinese population in Hong Kong and has been shown to be valid and reliable for screening cognitive impairment in this population 2, 3, 4, 5.

Comparison with standard MOCA

• The standard MOCA has been used as a reference for the development of the HK-MoCA, but the HK-MoCA has been adapted for the Chinese population in Hong Kong 3, 4.
• The HK-MoCA has been shown to be a useful cognitive screening instrument for detecting cognitive impairment in Chinese older adults, with a single cutoff score of 21/22 achieving screening purpose 4.
• The standard MOCA may not be as effective in detecting cognitive impairment in Chinese older adults, and the HK-MoCA may be a more suitable alternative 2, 3, 4.