The validation of the Beijing version of the Montreal Cognitive Assessment in Chinese patients undergoing hemodialysis

Autoři: Ru Tian aff001;  Yidan Guo aff001;  Pengpeng Ye aff002;  Chunxia Zhang aff001;  Yang Luo aff001
Působiště autorů: Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, China aff001;  Division of Injury Prevention and Mental Health National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China aff002
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0227073



Cognitive impairment is common among hemodialysis patient, but still lack adequate screening in clinical settings. The Montreal Cognitive Assessment (MoCA) is reportedly to be a sensitive screening tool for cognitive impairment, but its clinical value in patients undergoing hemodialysis is not well established. We aimed to validate the utility of the Beijing version of the MoCA (MoCA-BJ) for detecting cognitive impairment in comparison to a detailed neuropsychological battery as the gold standard.


We assessed 613 patients undergoing hemodialysis using the MoCA-BJ, the Mini-Mental State Examination (MMSE), and a comprehensive neuropsychological battery. Cognitive dysfunction was defined by the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Spearman’s correlation and linear regression were used to estimate the performance of the MoCA-BJ and MMSE in predicting cognitive impairment. A receiver operating characteristic (ROC) curve analysis was used to evaluate the utility of various cutoffs of the MoCA-BJ and MMSE for predicting cognitive impairment.


Cognitive impairment was diagnosed in 80.91% (496/613), 75.69% (464/613), and 61.34% (376 /613) of the patients using the DSM-V, MoCA-BJ, and MMSE, respectively. Spearman’s rank correlation analysis indicated that the MoCA-BJ was significantly correlated with the neuropsychological battery (rs = 0.639, p<0.001), whereas the MMSE had a weaker correlation with the battery. The area under the ROC curve for cognitive impairment diagnosis using the MoCA-BJ was 0.891 (95% confidence interval: 0.859–0.924) while using the MMSE was 0.823 (95% confidence interval: 0.786–0.860). The optimal MoCA-BJ cutoff score in discriminating patients with and without cognitive impairment was 24 points with a sensitivity of 0.877 and specificity of 0.752.


The MoCA-BJ offers good sensitivity and specificity levels in detecting cognitive impairment in hemodialysis patients. These findings support the utility of the MoCA-BJ as a screening tool for cognitive impairment in Chinese patients undergoing hemodialysis.

Klíčová slova:

Alzheimer's disease – Cognition – Cognitive impairment – Cognitive neurology – Chinese people – Medical dialysis – Neuropsychological testing – Neuropsychology


1. Zhang YH, Yang ZK, Wang JW, Xiong ZY, Liao JL, Hao L, et al. Cognitive Changes in Peritoneal Dialysis Patients: A Multicenter Prospective Cohort Study. Am J Kidney Dis. 2018; 72 (5):691–700. doi: 10.1053/j.ajkd.2018.04.020 30007504

2. Iyasere O, Okai D, Brown E. Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making. Clin Kidney J. 2017; 10 (1):89–94. doi: 10.1093/ckj/sfw128 28638609

3. Sarnak MJ, Tighiouart H, Scott TM, Lou KV, Sorensen EP, Giang LM, et al. Frequency of and risk factors for poor cognitive performance in hemodialysis patients. Neurology. 2013; 80 (5):471–80. doi: 10.1212/WNL.0b013e31827f0f7f 23303848

4. Sorensen EP, Sarnak MJ, Tighiouart H, Scott T, Giang LM, Kirkpatrick B, et al. The kidney disease quality of life cognitive function subscale and cognitive performance in maintenance hemodialysis patients. Am J Kidney Dis. 2012; 60 (3):417–26. doi: 10.1053/j.ajkd.2011.12.029 22425261

5. Drew DA, Weiner DE, Tighiouart H, Duncan S, Gupta A, Scott T, et al. Cognitive Decline and Its Risk Factors in Prevalent Hemodialysis Patients. Am J Kidney Dis. 2017; 69 (6):780–7. doi: 10.1053/j.ajkd.2016.11.015 28131531

6. Ciesielska N, Sokolowski R, Mazur E, Podhorecka M, Polak-Szabela A, Kedziora-Kornatowska K. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol. 2016; 50 (5):1039–52. doi: 10.12740/PP/45368 27992895

7. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53 (4):695–9. doi: 10.1111/j.1532-5415.2005.53221.x 15817019

8. Siciliano M, Chiorri C, Passaniti C, Sant'Elia V, Trojano L, Oho AUID, et al. Comparison of alternate and original forms of the Montreal Cognitive Assessment (MoCA): an Italian normative study. Neurol Sci. 2019; 40 (4):691–702. doi: 10.1007/s10072-019-3700-7 30637545

9. Bosco A, Oho AUID, Spano G, Caffo AO, Lopez A, Grattagliano I, et al. Italians do it worse. Montreal Cognitive Assessment (MoCA) optimal cut-off scores for people with probable Alzheimer's disease and with probable cognitive impairment. Aging Clin Exp Res. 2017; 29 (6):1113–20. doi: 10.1007/s40520-017-0727-6 28155182

10. Lu J, Li D, Li F, Zhou A, Wang F, Zuo X, et al. Montreal cognitive assessment in detecting cognitive impairment in Chinese elderly individuals: a population-based study. J Geriatr Psychiatry Neurol. 2011; 24 (4):184–90. doi: 10.1177/0891988711422528 22228824

11. Huang L, Chen KL, Lin BY, Tang L, Zhao QH, Lv YR, et al. Chinese version of Montreal Cognitive Assessment Basic for discrimination among different severities of Alzheimer's disease. Neuropsychiatr Dis Treat. 2018; 14:2133–40. doi: 10.2147/NDT.S174293 30174426

12. Yu J, Li J, Huang X. The Beijing version of the Montreal Cognitive Assessment as a brief screening tool for mild cognitive impairment: a community-based study. BMC Psychiatry. 2012; 12:156. doi: 10.1186/1471-244X-12-156 23009126

13. Tiffin-Richards FE, Costa AS, Holschbach B, Frank RD, Vassiliadou A, Kruger T, et al. The Montreal Cognitive Assessment (MoCA)—a sensitive screening instrument for detecting cognitive impairment in chronic hemodialysis patients. PLOS ONE. 2014; 9 (10):e106700. doi: 10.1371/journal.pone.0106700 25347578

14. Tholen S, Schmaderer C, Kusmenkov E, Chmielewski S, Forstl H, Kehl V, et al. Variability of cognitive performance during hemodialysis: standardization of cognitive assessment. Dement Geriatr Cogn Disord. 2014; 38 (1–2):31–8. doi: 10.1159/000357803 24556891

15. Dai XY, Ryan JJ, Paolo AM, Harrington RG. Factor analysis of the mainland Chinese version of the Wechsler Adult Intelligence Scale (WAIS-RC) in a brain-damaged sample. Int J Neurosci. 1990; 55 (2–4):107–11. doi: 10.3109/00207459008985956 2084035

16. Zhao Q, Guo Q, Li F, Zhou Y, Wang B, Hong Z. The Shape Trail Test: application of a new variant of the Trail making test. PLOS ONE. 2013; 8 (2):e57333. doi: 10.1371/journal.pone.0057333 23437370

17. Eadie K, Shum D. Assessment of visual memory: a comparison of Chinese characters and geometric figures as stimulus materials. J Clin Exp Neuropsychol. 1995; 17 (5):731–9. doi: 10.1080/01688639508405163 8557814

18. Li G, Tang H, Chen J, Qi X, Chen S, Ma J. Executive and Visuospatial Dysfunction in Patients With Primary Restless Legs Syndrome/Willis-Ekbom Disease: Study of a Chinese Population. J Clin Sleep Med. 2018; 14 (5):785–90. doi: 10.5664/jcsm.7106 29734979

19. Guo Q, Zhao Q, Chen M, Ding D, Hong Z. A comparison study of mild cognitive impairment with 3 memory tests among Chinese individuals. Alzheimer Dis Assoc Disord. 2009; 23 (3):253–9. doi: 10.1097/WAD.0b013e3181999e92 19812468

20. Chen X, Zhang R, Xiao Y, Dong J, Niu X, Kong W. Reliability and Validity of the Beijing Version of the Montreal Cognitive Assessment in the Evaluation of Cognitive Function of Adult Patients with OSAHS. PLOS ONE. 2015; 10 (7):e0132361. doi: 10.1371/journal.pone.0132361 26208289

21. Yang Z, Holt HK, Fan JH, Ma L, Liu Y, Chen W, et al. Optimal Cutoff Scores for Alzheimer's Disease Using the Chinese Version of Mini-Mental State Examination Among Chinese Population Living in Rural Areas. Am J Alzheimers Dis Other Demen. 2016; 31 (8):650–7. doi: 10.1177/1533317516662336 27659393

22. Nazem S, Siderowf AD, Duda JE, Have TT, Colcher A, Horn SS, et al. Montreal cognitive assessment performance in patients with Parkinson's disease with "normal" global cognition according to mini-mental state examination score. J Am Geriatr Soc. 2009; 57 (2):304–8. doi: 10.1111/j.1532-5415.2008.02096.x 19170786

23. Nie K, Zhang Y, Wang L, Zhao J, Huang Z, Gan R, et al. A pilot study of psychometric properties of the Beijing version of Montreal Cognitive Assessment in patients with idiopathic Parkinson's disease in China. J Clin Neurosci. 2012; 19 (11):1497–500. doi: 10.1016/j.jocn.2011.11.039 22959678

24. Eggers B, Hermann W, Barthel H, Sabri O, Wagner A, Hesse S. The degree of depression in Hamilton rating scale is correlated with the density of presynaptic serotonin transporters in 23 patients with Wilson's disease. J Neurol. 2003; 250 (5):576–80. doi: 10.1007/s00415-003-1039-7 12736737

25. First MB. Diagnostic and statistical manual of mental disorders, 5th edition, and clinical utility. J Nerv Ment Dis. 2013; 201 (9):727–9. doi: 10.1097/NMD.0b013e3182a2168a 23995026

26. Lin KN, Wang PN, Liu CY, Chen WT, Lee YC, Liu HC. Cutoff scores of the cognitive abilities screening instrument, Chinese version in screening of dementia. Dement Geriatr Cogn Disord. 2002; 14 (4):176–82. doi: 10.1159/000066024 12411759

27. Coen RF, Cahill R, Lawlor BA. Things to watch out for when using the Montreal cognitive assessment (MoCA). Int J Geriatr Psychiatry. 2011; 26 (1):107–8. doi: 10.1002/gps.2471 21157857

28. Costa AS, Tiffin-Richards FE, Holschbach B, Frank RD, Vassiliadou A, Kruger T, et al. Clinical predictors of individual cognitive fluctuations in patients undergoing hemodialysis. Am J Kidney Dis. 2014; 64 (3):434–42. doi: 10.1053/j.ajkd.2014.02.012 24679895

29. Lifshitz M, Dwolatzky T, Press Y. Validation of the Hebrew version of the MoCA test as a screening instrument for the early detection of mild cognitive impairment in elderly individuals. J Geriatr Psychiatry Neurol. 2012; 25 (3):155–61. doi: 10.1177/0891988712457047 23124009

30. Damian AM, Jacobson SA, Hentz JG, Belden CM, Shill HA, Sabbagh MN, et al. The Montreal Cognitive Assessment and the mini-mental state examination as screening instruments for cognitive impairment: item analyses and threshold scores. Dement Geriatr Cogn Disord. 2011; 31 (2):126–31. doi: 10.1159/000323867 21282950

31. Luis CA, Keegan AP, Mullan M. Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry. 2009; 24 (2):197–201. doi: 10.1002/gps.2101 18850670

32. Seidel UK, Gronewold J, Volsek M, Todica O, Kribben A, Bruck H, et al. The prevalence, severity, and association with HbA1c and fibrinogen of cognitive impairment in chronic kidney disease. Kidney Int. 2014; 85 (3):693–702. doi: 10.1038/ki.2013.366 24088956

33. Hermann DM, Kribben A, Bruck H. Cognitive impairment in chronic kidney disease: clinical findings, risk factors and consequences for patient care. J Neural Transm (Vienna). 2014; 121 (6):627–32.

34. Lee SH, Cho A, Min YK, Lee YK, Jung S. Comparison of the montreal cognitive assessment and the mini-mental state examination as screening tests in hemodialysis patients without symptoms. Ren Fail. 2018; 40 (1):323–30. doi: 10.1080/0886022X.2018.1455589 29633885

35. Kopecek M, Stepankova H, Lukavsky J, Ripova D, Nikolai T, Bezdicek O. Montreal cognitive assessment (MoCA): Normative data for old and very old Czech adults. Appl Neuropsychol Adult. 2017; 24 (1):23–9. doi: 10.1080/23279095.2015.1065261 27144665

36. Naganuma T, Takemoto Y. New aspects of cerebrovascular diseases in dialysis patients. Contrib Nephrol. 2015; 185:138–46. doi: 10.1159/000380978 26023023

37. Zheng K, Wang H, Hou B, You H, Yuan J, Luo K, et al. Malnutrition-inflammation is a risk factor for cerebral small vessel diseases and cognitive decline in peritoneal dialysis patients: a cross-sectional observational study. BMC Nephrol. 2017; 18 (1):366. doi: 10.1186/s12882-017-0777-1 29262796

38. Mok EH, Lam LC, Chiu HF. Category verbal fluency test performance in Chinese elderly with Alzheimer's disease. Dement Geriatr Cogn Disord. 2004; 18 (2):120–4. doi: 10.1159/000079190 15211065

39. Zhou A, Jia J. A screen for cognitive assessments for patients with vascular cognitive impairment no dementia. Int J Geriatr Psychiatry. 2009; 24 (12):1352–7. doi: 10.1002/gps.2265 19347838

Článok vyšiel v časopise


2020 Číslo 1

Najčítanejšie v tomto čísle

Tejto téme sa ďalej venujú…

Zabudnuté heslo

Nemáte účet?  Registrujte sa

Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.


Nemáte účet?  Registrujte sa