Detecting cognitive decline in aging adults

Assessing the presence of cognitive decline in aging adults is not an easy task.

So how do we assess the presence of a “cognitive decline” (often referred to as “memory loss”) ?   Excellent question! When visiting your general physician, he/she/they may use cognitive screenings to test your memory. They might use mini tests to check how is your memory. These tests are imperfect but they are a good start!

An article The Clinical Neuropsychologist (an established scientific journal) published in July 2022 reminds us how one size does not fit all when it come to those quick cognitive screenings. An idea we also suggested in 2013.

To really determine is someone has declined cognitively takes time, tools and clinical sense. A neuropsychological evaluation includes tailored comparison and interpretations helps make sure we conclude to the right diagnosis. Learn more about neuropsychology and human memory, click here.

Published this July (Ratcliffe et al 2022), this interesting article reiterates some of the ideas we have initially suggested in 2013 (Genevieve Gagnon and colleagues in 2013 – scientific paper derived from our work in London, Ontario). In short, cognitive screening are good but far from perfect because one size does not fit all!

Abstract from Ratcliffe et al (2022) in “Classification statistics of the Montreal Cognitive Assessment (MoCA): Are we interpreting the MoCA correctly?”

Objective : The Montreal Cognitive Assessment (MoCA) is a common cognitive screener for detecting mild cognitive impairment (MCI). However, previously suggested cutoff scores of 26/30 and above is often criticized and lacks racial diversity. The purpose of this study is to investigate the potential influence of race on MoCA classification cutoff score accuracy.

Method : Data were obtained from the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set and yielded 4,758 total participants. Participants were predominately White (82.8%) and female (61.7%) with a mean age of 69.3 years (SD = 10.3) and education level of 16.3 years (SD = 2.6). Based on NACC’s classification, participants were either cognitively normal (n = 3,650) or MCI (n = 1,108).

Results: Sensitivity and specificity analyses revealed that when using the cutoff score of ≤26/30, the MoCA correctly classified 73.2% of White cognitively normal participants and 83.1% of White MCI participants. In contrast, this criterion correctly classified 40.5% of Black cognitively normal participants and 90.8% of Black MCI participants. Our sample was highly educated; therefore, we did not observe significant differences in scores when accounting for education across race. Classification statistics are presented.

Conclusions : Black participants were misclassified at a higher rate than White participants when applying the ≤26/30 cutoff score. We suggest cutoff scores of ≤25/30 be applied to White persons and ≤22/30 for Black persons. These findings highlight the need for racially stratified population-based norms given the high misclassification of Black participants without such adjustment.


  • Lauren N. Ratcliffe, Taylor McDonald, Brittany Robinson, John R. Sass, David W. Loring & Kelsey C. Hewitt (2022) Classification statistics of the Montreal Cognitive Assessment (MoCA): Are we interpreting the MoCA correctly?, The Clinical Neuropsychologist. 
  • Gagnon, G.Hansen, K.Woolmore-Goodwin, S.Gutmanis, I.Wells, J.Borrie, M., & Fogarty, J. (2013). Correcting the MoCA for education: Effect on sensitivity. The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques, 40(5), 678683.