The Montreal Cognitive Assessment: Normative Data from a Large, Population-Based Sample of Healthy Adults in China

Background The Montreal Cognitive Assessment (MoCA) is a valuable tool for detecting cognitive impairment, but its accuracy is significantly influenced by demographic and socio-cultural factors. Consequently, the development of appropriate normative values becomes particularly crucial in ensuring its reliable use and interpretation. Objective Generate MoCA normative values based on demographics for healthy chinese adults. Methods The assessment conducted in this study utilizes the MoCA scale, specifically employing the Mandarin-8.1 version (Chinese Mandarin version). Based on the geographical distribution of administrative regions in mainland china, this study recruited a total of 3,097 healthy individuals aged over 20 years. Drawing on insights from prior normative studies, we performed multiple linear regression analysis, incorporating age, gender, and education level as predictor variables, to examine their associations with the total score and sub-cognitive domains of MoCA. Subsequently, we established normative values and cut-off values stratified by age and education level. Results The participants in this study (n=3,097) exhibit a balanced gender distribution, with an average age of 54.46 years (SD 14.38) and an average education period of 9.49 years (SD 4.61). The study population demonstrates an average MoCA score of 23.25 points (SD 4.82). The findings from the multiple linear regression analysis indicate that the total score of MoCA is influenced by age and education level, collectively accounting for 46.8% of the total variance. Higher age and lower education level are correlated with lower MoCA total scores. Conclusion This study offers normative MoCA values specific to the Chinese population. Furthermore, the research findings indicate that a score of 26 may not represent the most optimal cut-off value. When assessing MoCA scores, it is imperative to comprehensively account for the participants’ age and educational background. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by the National Key R&D Program of China (Grant Nos. 2021YFC2500100), the Clinical Medical Research and Transformation Project of Anhui (Grant Nos.202204295107020028 and 202204295107020006), the Anhui Provincial Key Research and Development Project (Population Health Special Project, 202104j07020033), the National Natural Science Foundation of China (Grant Nos. 82171917) and the Science and Technology Innovation 2030- "Brain Science and Brain-like Research" Major Project (Grant Nos.2021ZD0201801). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All participants provided written informed consent, and the research scheme was approved by the Anhui Medical University Ethics Committee. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes