{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T09:14:07Z","timestamp":1783415647446,"version":"3.54.6"},"reference-count":30,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Montreal Cognitive Assessment (MoCA) is widely used for cognitive screening. Despite numerous studies showing that MoCA scores are affected by demographic variables including age, education, and race, the instrument is typically evaluated using a raw score or simple one-point education correction in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In this study, we comprehensively evaluate the diagnostic accuracy of the MoCA in a large cohort of individuals being evaluated for mild cognitive impairment or dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used data from the National Alzheimer's Coordinating Center (NACC) database to examine diagnostic accuracy of the MoCA, using both raw scores and Z-scores subject to non-linear demographic correction. We present comprehensive accuracy statistics, concordance with\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      \u03b54 status, and predictive validity of a mild cognitive impairment classification for the subsequent development of dementia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We find that non-linear demographic correction modestly enhances diagnostic performance for individuals with mild cognitive impairment and dementia and results in classifying a higher proportion of\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      \u03b54 homozygous participants as individuals with dementia as compared to MoCA raw scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Non-linear demographic correction may improve the diagnostic accuracy of the MoCA and increase concordance with a major known risk factor for Alzheimer's disease (i.e.,\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      \u03b54 status).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877261431359","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T14:19:21Z","timestamp":1774275561000},"page":"294-300","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Non-linear demographic correction enhances the diagnostic utility of the Montreal Cognitive Assessment"],"prefix":"10.1177","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4661-0967","authenticated-orcid":false,"given":"Peter V.","family":"Stewart","sequence":"first","affiliation":[{"name":"Neuropsychology Westchester, Atrium Health Wake Forest Baptist"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6919-4593","authenticated-orcid":false,"given":"Joseph J.","family":"Boscarino","sequence":"additional","affiliation":[{"name":"James A. Haley Veterans\u2019 Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2212948"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.53221.x"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.011226"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadm.2018.09.003"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/13854046.2022.2086487"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1080\/13854046.2021.1967450"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318230208a"},{"key":"e_1_3_3_9_2","article-title":"Montreal Cognitive Assessment for the diagnosis of Alzheimer\u2019s disease and other dementias","volume":"2015","author":"Davis DHJ","year":"2015","unstructured":"Davis DHJ, Creavin ST, Yip JLY, et al. Montreal Cognitive Assessment for the diagnosis of Alzheimer\u2019s disease and other dementias. Cochrane Database Syst Rev 2015; 2015: CD010775.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/13825585.2015.1041449"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100014918"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/arclin\/acr116"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-020-00603-8"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/WNN.0b013e31828b7d26"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4756"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.011036"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18029"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jagp.2018.09.009"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadm.2019.08.003"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0000000000000223"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0000000000000279"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5227"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.11.2412-a"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3"},{"key":"e_1_3_3_26_2","first-page":"1","article-title":"Test statistics for comparing two proportions with partially overlapping samples","volume":"10","author":"Derrick B","year":"2015","unstructured":"Derrick B, Dobson-Mckittrick A, Toher D, et al. Test statistics for comparing two proportions with partially overlapping samples. J Appl Quant Methods 2015; 10: 1\u201314.","journal-title":"J Appl Quant Methods"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0106284"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/arclin\/acp111"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-02931-w"},{"key":"e_1_3_3_30_2","first-page":"238","article-title":"Montreal Cognitive Assessment performance among community-dwelling African Americans","volume":"32","author":"Rossetti HC","year":"2017","unstructured":"Rossetti HC, Lacritz LH, Hynan LS, et al. Montreal Cognitive Assessment performance among community-dwelling African Americans. Arch Clin Neuropsychol 2017; 32: 238\u2013244.","journal-title":"Arch Clin Neuropsychol"},{"key":"e_1_3_3_31_2","article-title":"Alzheimer\u2019s Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer\u2019s Disease and Related Disorders (DETeCD-ADRD): executive summary of recommendations for primary care","volume":"21","author":"Atri A","year":"2025","unstructured":"Atri A, Dickerson BC, Clevenger C, et al. Alzheimer\u2019s Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer\u2019s Disease and Related Disorders (DETeCD-ADRD): executive summary of recommendations for primary care. 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