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Sains Malaysiana 45(9)(2016): 1337–1343 Validation and Optimal Cut-Off Scores of
the Bahasa Malaysia Version of the Montreal Cognitive Assessment
(MoCA-BM) for Mild Cognitive Impairment among Community Dwelling
Older Adults in Malaysia (Keesahan dan Skor Titik
Potong Optimum Versi Bahasa Malaysia Penilaian Kognitif Montreal
(MoCA-BM) untuk Kecelaan Kognitif Ringan dalam
Kalangan Komuniti Rumah Warga Tua di Malaysia) NORMAH
CHE
DIN1*,
SUZANA
SHAHAR2,
BAITIL
HUSNA
ZULKIFLI1,
ROSDINOM
RAZALI3,
CHYN AI
VYRN4
& AZHADI OMAR5 1Health Psychology Programme,
School of Healthcare Sciences, Faculty of Health Sciences Universiti Kebangsaan
Malaysia, Jalan Raja Muda Abd Aziz, 50300 Kuala Lumpur, Federal
Territory, Malaysia 2Dietetic Programme,
Centre of Healthcare Sciences, Faculty of Health Sciences, Universiti
Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur,
Federal Territory Malaysia 3Universiti Kebangsaan
Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun
Razak, Cheras, 56000 Kuala Lumpur, Federal Territory, Malaysia 4Department of Medicine,
Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Federal
Territory, Malaysia 5Institute for Public
Health, Jalan Bangsar, Federal Hill, 50590 Kuala Lumpur, Federal
Territory Malaysia Diserahkan: 26 Oktober
2015/Diterima: 25 April 2016 ABSTRACT The goal of this study was
to examine the reliability and validity of the Bahasa Malaysia version
of the Montreal cognitive assessment (MoCA-BM) and to determine its
optimal cut-off score among older adults with mild cognitive impairment
(MCI),
after adjustments for age, gender, levels of education, physical
functioning and depressive symptoms. A total of 2237 community dwelling
older adults aged 60 years and above were randomly selected for
the study, excluding those with MMSE
score below 14. Instruments administered were the
MoCA-BM,
the Malay Mini-Mental State Examination (MMMSE), the Rey Auditory Verbal
Learning Test (RAVLT), the Digit Span and the Digit
Symbol subtests of the Wechsler Adult Intelligence Scale (WAIS),
activities of daily living (ADL) and the Geriatric Depression
Scale (GDS). MCI were
determined using the Petersen’s 2014 criteria as the gold standard.
SPSS
version 22 was used for reliability and validity analysis
and optimal cut-off score detection. Cronbach’s α of the MoCA-BM was
0.691 and concurrent validity was high between MoCA-BM and
MMMSE
scores (r=0.741). Optimal cut-off point for
MoCA-BM
to detect MCI among older adults in Malaysia was
17/18, with sensitivity of 68.2% and specificity of 61.3%. Using
this cut-off, 38.9% of participants were detected to be at risk
of MCI.
In conclusion, MoCA-BM is a reliable and valid screening
instrument for MCI among Malaysian elderly community.
The newly derived optimal cut-off for MCI is much lower than the original
MoCA with modest ability to discriminate between normal
and MCI older adults in the community. Keywords: Mild cognitive impairment;
Mini Mental Status Examination; Montreal Cognitive Assessment; older
adults; validation ABSTRAK Matlamat kajian ini adalah
untuk mengkaji kebolehpercayaan dan keesahan Penilaian Kognitif
Montreal (MoCA-BM)
versi Bahasa Malaysia dan untuk menentukan skor titik potong optimum
dalam kalangan warga tua yang mempunyai kecelaan kognitif ringan
(MCI)
selepas dilakukan penyesuaian untuk umur, jantina, tahap pendidikan,
kefungsian fizikal dan simptom kemurungan. Sejumlah 2237 warga tua
yang tinggal dalam komuniti rumah berumur 60 tahun ke atas telah
dipilih secara rawak untuk kajian ini kecuali mereka yang mempunyai
skor MMSE 14 ke bawah. Instrumen yang
digunakan adalah MoCA-BM, Pemeriksaan Keadaan Mental Mini
Bahasa Malaysia (MMMSE), Ujian Pembelajaran Lisan Pendengaran
Rey (RAVLT), sub ujian Digit Span dan Digit
Simbol dari Skala Kecerdasan Dewasa Wechsler (WAIS),
Aktiviti Hidup Seharian (ADL) dan Skala Kekecewaan Geriatrik (GDS).
MCI
ditentukan menggunakan kriteria Petersen 2014 sebagai
piawai emas. SPSS versi 22 telah digunakan untuk analisis kebolehpercayaan
dan keesahan dan penentuan skor titik potong optimum. α Cronbach
untuk MoCA-BM
adalah 0.691 dan keesahan serentak adalah tinggi antara
MoCA-BM
dan skor MMMSE (r=0.741).
Titik potong optimum MoCA-BM untuk menentukan MCI
dalam kalangan warga tua di Malaysia adalah 17/18,
dengan kepekaan 68.2% dan kekhususan 61.3%. Menggunakan titik potong
ini, 38.9% peserta dikenal pasti mempunyai risiko MCI. Kesimpulannya, MoCA-BM adalah
satu instrumen saringan MCI yang boleh dipercayai dan sah dalam
kalangan komuniti warga tua Malaysia. Titik potong yang baru diperoleh
untuk MCI adalah lebih rendah berbanding MoCA asal
dengan kebolehan sederhana untuk membezakan antara warga tua yang
normal dan warga tua MCI dalam komuniti. Kata kunci: Kecelaan kognitif ringan; keesahan; Penilaian Kognitif
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