Without a general factor present, the total score will not represent the overlying construct (the subject’s cognitive status) and will therefore be less meaningful ( Sala et al., 2020). For the total MoCA score to be considered viable and true, the factorial structure of the test should be unidimensional (i.e., have one general factor present that relates all the items together by explaining more than 50% of the variance) regardless of how many other dimensions the model has. The MoCA’s psychometric properties are an important aspect to analyze as it is concerned with the reliability of the total score in representing the subject’s real cognitive status as well as the interpretations drawn from it. Nevertheless, regarding the construct of the MoCA test itself, the psychometric properties of the test remain under debate as not many studies have delineated its factorial structure and measurement invariance. Since its appearance, many validation studies continuously report that the MoCA (English version and other language versions) had good diagnostic accuracy in discriminating MCI and AD patients, and better psychometric properties compared to other cognitive impairment tests ( Fujiwara et al., 2010 Freitas, Simões, Alves, et al., 2012 Freitas et al., 2013 Azdad et al., 2019 Freud et al., 2020 Serrano et al., 2020 Hemrungrojn et al., 2021). The MoCA is a 10-minute test for older adults that evaluates cognitive domains such as executive function, visuospatial function, memory, language, orientation, and attention. (2005) to address shortcomings of the Mini-Mental State Examination (MMSE), a widely used cognitive function test that was less sensitive to MCI. The MoCA was developed by Nasreddine et al. Those with single-domain aMCI are at higher risk of developing dementia, whereas naMCI is associated with non-AD dementias ( Csukly et al., 2016).Ī well-known tool for the detection of AD and MCI is the Montreal Cognitive Assessment (MoCA). MCI can be further divided into non-amnestic (naMCI) and amnestic (aMCI) MCI that can either be multiple domain or single domain. (1997), the diagnosis for MCI is made when a subject: (1) has memory complaints and abnormal memory function for their age, (2) has normal general cognitive function and activities of daily living, and (3) does not have dementia. MCI is an intermediate stage that is often, but not always, a transitional phase between normal age-related cognitive decline and dementia ( Anderson, 2019). This neurodegenerative disease is clinically characterized by a gradual decline in cognitive ability, which is in part due to the presence of neuritic beta-amyloid plaques and neurofibrillary tau protein tangles ( Murphy and LeVine, 2010).Īnother condition characterized by neurocognitive decline is Mild Cognitive Impairment (MCI). Accounting for 60-80% of all dementia cases is Alzheimer’s Disease (AD) ( Alzheimer’s Association, 2020), a progressive brain disorder that is a major global healthcare burden. With this, the prevalence of dementia is also expected to significantly increase ( Norton, Matthews and Brayne, 2013). The proportion of the world’s elderly population (age over 60 years) is projected to increase to 22% by 2050 (almost double the proportion in 2015) ( Kanasi, Ayilavarapu and Jones, 2016).