Psychometric Properties of the Montreal Cognitive Assessment (MoCA) to Detect Major Neurocognitive Disorder Among Older People in Ethiopia: A Validation Study

Background: Cognition is one of the most complex functions of the human brain, and major neurocognitive disorders affect this function causing a wide array of problems in an individual's life. Screening for major neurocognitive disorders can be helpful in designing and implementing early interventions. Purpose: This study was designed to assess the reliability and validity of the Montreal Cognitive Assessment (MoCA) tool to detect major neurocognitive disorders among older people in Ethiopia. Methods: One hundred and sixteen randomly selected older adults in Ethiopia were involved in a cross-sectional study. The Diagnostic and Statistical Manual of Mental Disorders criteria for major neurocognitive disorders was used as a gold standard. Data were analyzed using STATA v16 statistical software. Receiver operating curve analysis was performed, and inter-rater, internal consistency reliabilities, content, criterion and construct validities were determined. Statistically significance was declared at a p-value of <0.05. Results: The study had a 100% response rate. The mean age of the study participants was 69.87 +/- 7.8. The inter-rater reliability value was 0.96, and Cronbach's alpha was 0.79. The optimal cutoff value was <= 21, and Montreal Cognitive Assessment has an area under curve value of 0.89. The sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values of MoCA are 87.18%, 74.03%, 3.35, 0.17, 63%, and 91.9%, respectively. The tool also has good concurrent and construct validities. Conclusion: The Montreal Cognitive Assessment tool was a reliable and valid tool to detect major neurocognitive disorder. It can be incorporated into the clinical and research practices in developing countries.