Montreal Cognitive Assessment MoCA‐XpressO: Validation of a Digital Self‐administered Cognitive Pre‐screening Tool for the General Adult Population

Abstract Background The population is aging worldwide, and the prevalence of Alzheimer’s dementia is expected to increase, adding demand for cognitive screening. A brief pre‐screening tool may allow self‐tracking of cognitive function and identify the “worried well” population, whom if pre‐screened will show no objective cognitive impairment, consequently reduce demand for cognitive screening. Therefore, we developed the MoCA‐XpressO, a brief home‐based cognitive pre‐screening tool. The purpose of this tool is to establish if further cognitive testing is necessary. Method We conducted a validation study for MoCA‐XpressO compared to MoCA test (version 8.1) as gold standard. Participants were recruited from MoCA clinic and a family practice. Ethics approval was received, and all participants provided informed consent. A crossover study design was applied to the MoCA‐XpressO and standard MoCA test; participants were randomized for the order of administration. Inclusion criteria included age ≥50, fluency in English and/or French, and minimum 6 years of education. Exclusion criteria included MoCA total score<11, and completion of MoCA during recent 3 months. Logistic regression model was built, and the accuracy of the model was evaluated by the sensitivity, specificity, and area under the Receiver Operating Characteristic (ROC) curve. Result The MoCA‐XpressO evaluates 3 cognitive domains: processing speed, executive functions, and memory. Preliminary analysis (n = 44) showed a strong association between (1) MoCA Memory Index Score (MIS) and MoCA‐XpressO memory task score (p‐values<.001); (2) MoCA Executive Index Score and MoCA‐XpressO logical task score (p‐values<.03); and (3) total scores of MoCA test and MoCA‐XpressO (p‐values<.005). The ROC curve of the logistic model has an Area Under the Curve (AUC) around 0.85. With a cutoff probability of 0.45, the sensitivity was 89.2% and the specificity was 62.5%; with a cutoff probability of 0.6, the sensitivity was 71.4% and specificity was 87.5%. Full analysis (n≥80) will be available in July 2023. Conclusion The high values of AUC (0.85), indicate that MoCA‐XpressO may be strongly predictive of the standard MoCA. This suggests MoCA‐XpressO is a valid home‐based cognitive pre‐screening tool, also allowing self‐tracking of cognition over time. MoCA‐XpressO may differentiate the “worried‐well” from cognitively impaired population, consequently, reduce the high demand for cognitive screening in healthcare systems.

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