Validation and Reliability of the Turkish Version of the Montreal Cognitive Assessment-Basic (MoCA-B) in Individuals With Low Educational Level

Antalya Training and Research Hospital166 enrolled

Overview

This study aimed to evaluate the validity, reliability, and diagnostic accuracy of the Turkish version of MoCA-B in distinguishing healthy controls, mild cognitive impairment (MCI), and dementia patients within a low-education population.

The prevalence of dementia is steadily increasing, and recognizing cognitive impairment at an early stage-especially during mild cognitive impairment (MCI), before full diagnostic criteria for dementia are met-is crucial. Cognitive screening tools used in individuals with low educational levels often fail to detect MCI. The illiterate version of the Mini-Mental State Examination (MMSE) is insufficient for identifying MCI and early dementia, resulting in delayed diagnosis. The MoCA-Basic (MoCA-B), adapted for low-educated populations and translated into Turkish, has not undergone a validation and reliability study; therefore, it is not routinely used in clinical practice. This study aimed to evaluate the validity and reliability of the Turkish MoCA- B in detecting MCI and dementia, and to compare its diagnostic performance with the MMSE and the Clinical Dementia Rating (CDR). This study included 55 patients with MCI, 56 with dementia, and 55 healthy controls (total n=166) who presented to the Dementia and Neurology Clinics of Antalya Training and Research Hospital between January 2024 and November 2025. After a detailed mental status examination, participants underwent MoCA-B, MMSE (illiterate version), and CDR assessments. Internal consistency was measured using Cronbach's alpha, and test-retest reliability using the intraclass correlation coefficient (ICC). Group differences were analyzed with one-way ANOVA and Tukey post hoc testing. Correlations between MoCA-B, MMSE, and CDR were evaluated with Pearson correlation. Diagnostic accuracy was assessed through ROC analyses, and optimal cut- off values were determined using the Youden index.

Study Type

OBSERVATIONAL

Enrollment

166

Conditions

Behavioral and Psychological Symptoms of Dementia

Eligibility

Sex: ALLMin age: 50 YearsMax age: 100 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Age 50-100 years * Presented with memory complaints and were evaluated in the Neurology/Dementia outpatient clinics of Antalya Training and Research Hospital (Jan 2024-Nov 2025) * Low educational attainment (illiterate to primary school level) * Provided informed consent Exclusion Criteria: * Active psychiatric disorders / active psychopathology * Intracranial mass lesions * Secondary causes of dementia * Severe medical conditions affecting cognition * History of traumatic brain injury

Outcomes

Primary Outcomes

MoCA-B cut off points

Calculating cutoff values for dementia and MCI in untrained individuals using the MoCA-B test.

Time frame: at baseline and after 4 weeks (test-retest)

Secondary Outcomes

Correlations of MoCA-B total score with MMSE and CDR

As a secondary endpoint, Pearson correlation (level of relationship) of the MoCA-B total score with MMSE and/or CDR total scores was evaluated to demonstrate concurrent criterion validity.

Time frame: data were collected between January 2024 and November 2025.

Subdomain-level analyses

The subdomain-level analyses for the MoCA-B test aimed to determine which domains best facilitated diagnostic differentiation by evaluating, using ANOVA and post-hoc tests, whether subtest scores such as executive function, memory, and attention differed significantly between control, HKB, and dementia groups.

Time frame: Data were collected between January 2024 and November 2025