Recent studies in mainland China suggested that the cutoffs for MCI were 24 in a clinical sample and ranged from 18 to 25 in normative samples. Unfortunately, only 86% cases could be correctly identified as either normal or MCI. A recent meta-analysis of studies with strictly verifiable criteria of MCI suggested that the optimal cutoff was 23 based on balanced sensitivity (the probability of true positives) and specificity (the probability of true negatives) as well as samples of different language, cultural, and educational background.
Nevertheless, different from the original cutoff score of 24, various cutoffs have been identified, ranging from 18/19 to 26/27 across different cultures. The optimal cutoff score for screening mild cognitive impairment (MCI) in older adults has been widely explored in applying the Montreal Cognitive Assessment (MoCA), which is a tool designed exclusively for screening MCI in older adults. Older adults who scored within this gray zone should be monitored for potential interventions. A range of 18–24 MoCA scores might serve as a better screening criterion of MCI. Some categorically different cases of MCI cannot be captured with any single MoCA sum score. Latent variable classification modeling provides another option to identify MCI in older adults. For those cases with MoCA scores above 18 and below 24, it is not certain if they are in the normal or the severely impaired classes. The normal class averaged a MoCA score of 24, while the severely impaired class averaged a score below 18. A 3-class model (normal, mildly impaired, and severely impaired) was found to fit the data best. Models with different numbers of classes were compared in terms of information criteria, likelihood ratio test, entropy, and interpretability. Mixture modeling was applied to the data with certain covariates and MoCA sum scores as the outcome of the latent class. Participants, selected from 13 communities in Wuhan, China, were tested with the Chinese version of MoCA and rated with the Activities of Daily Living and the Clinical Dementia Rating scales. It was unknown how taking a classifying approach might reveal the cutoff score for identifying mildly cognitively impaired older adults. It is argued that to seek a cutoff score is essential to classify test participants. Cutoff scores of the Montreal cognitive assessment (MoCA) for screening mild cognitive impairment in older adults differ across the world and within the Chinese culture.
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