MoCA Talk #23:
From JAMA to GUIDE: A 20-Year Journey Advancing Dementia Care (Malaz Boustani, MD, MPH) - Thu, June 5, 2025, 12:00 PM EDT
The MoCA-HI is an adapted version of the standard MoCA designed to facilitate the detection of cognitive impairment in adults with hearing loss. It reduces reliance on auditory instructions by providing instructions on flashcards, and tasks that rely on auditory input have been replaced with suitable alternatives.
Purpose: It is intended to screen for mild cognitive impairment in individuals with hearing impairments, ensuring that assessment results reflect cognitive abilities rather than hearing limitations.
Administration time
Approximately 10 minutes.
Setting
The MoCA-HI should be administered in a clinical setting or other calm, controlled, distraction-free environment.
Form
Paper-based; the examiner presents standardized stimuli and records the examinee’s responses directly on the test sheet.
Cost
Freely available for clinical and educational use; a license is required for commercial use.
The MoCA-HI is scored manually, in accordance with the guidelines provided in the instructional PDF. The total score ranges from 0 to 30 points, with higher scores indicating better cognitive functioning. Scores of 25 or higher are generally considered within normal limits.
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| Property | Summary of Findings Across Studies | Typical Values / Ranges | Interpretation |
|---|---|---|---|
Diagnostic Accuracy | Effectively distinguishes dementia and MCI from normal cognition; optimized cut-offs improve detection. | AUC ≈ 0.97; Sensitivity 92– 97%, Specificity 90–96% | Strong tool for screening cognitive impairment in adults with hearing loss. |
Test–Retest Reliability | Consistent total scores across repeated administrations. | ICC ≈ 0.92 | Excellent temporal stability; scores are reliable over time. |
Internal Consistency | Test items measure cognitive abilities cohesively. | Cronbach’s α = 0.80 | Good internal consistency, indicating reliable measurement of cognition. |
Cross-Cultural Validity | Performance influenced by language and culture; local norms recommended. | Cultural group explains ~6.9% of variance; mean differences up to ~2.6 points | Requires validation in different languages/ cultures for accurate interpretation. |
Content Validity | Adapted versions use translation, stimulus adjustment, and expert review. | Agreement and content validity indices acceptable | Test is conceptually and culturally appropriate after adaptation. |
Criterion vs. Construct Validity | Criterion validity distinguishes cognitive decline; construct validity (vs MMSE) weaker in some adaptations. | Criterion: significant group differences; Construct: ρ ≈ 0.38, p > 0.05 | Strong criterion validity; construct validity requires further study. |