Is the Bahasa Malaysia version of the Montreal Cognitive Assessment (MoCA-BM) a better instrument than the Malay version of the Mini Mental State Examination (M-MMSE) in screening for mild cognitive impairment (MCI) in the elderly?

Introduction: Mild Cognitive Impairment (MCI) is a known precursor to Alzheimer disease, yet there is a lack of validated screening instruments for its detection among the Malaysian elderly.
Objective: To compare the Bahasa Malaysia version of the Montreal Cognitive Assessment (MoCA-BM) with the Malay version of the Mini Mental State Examination (M-MMSE) in the detection of MCI among the Malaysian elderly.
Methodology: This is a cross-sectional study conducted at the primary care centre of Universiti Kebangsaan Malaysia, Kuala Lumpur from December 2011 to mid-January 2012. Subjects aged 60 and above were recruited using systematic sampling method. Cut-off scores of 22/23 for MoCA-BM and 25/26 for M-MMSE were adopted. Kappa value and Pearson's correlation coefficient were used to ascertain the correlation between MOCA-BM and M-MMSE. Data were analysed using Mann-Whitney and Chi Square tests.
Results: The mean age of the 180 subjects enrolled was 65.3 years (SD=5.4). They had a median of 6 years (IqR 25-75=5-11) total formal education. The prevalence of MCI using MoCA-BM and M-MMSE was 55.6% and 32.8% respectively. The odds of developing MCI were 1.153 (95% CI=1.055, 1.261; p<0.05) for every 1 year increase in age, 0.813 (95% CI=0.690, 0.959; p<0.05) with every extra year of education. Increasing age and lower education level were significantly associated with MCI. The MoCA-BM showed good internal consistency with Cronbach's alpha of 0.80. It had moderate correlation with M-MMSE (Pearson correlation coefficient=0.770, p<0.001) and moderate agreement for detecting MCI with Kappa values of 0.497 (p<0.001).
Conclusion: The prevalence of MCI was higher using MoCA-BM compared to M-MMSE. Both instruments showed moderate concordance for screening MCI with correlation of their scores.
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