Linking the Scores of the Montreal Cognitive Assessment 5-min and the interRAI Cognitive Performance Scale in Older Adults With Mild Physical or Cognitive Impairment

Abstract

Background: Bridging scores generated from different cognitive assessment tools is necessary to efficiently track changes in cognition across the continuum of care. This study linked scores from the Montreal Cognitive Assessment-5 min (MoCA 5-min) to the interRAI cognitive Performance Scale (CPS), commonly adopted tools in clinical and long-term care settings, respectively. Methods: We included individual-level data from persons who participated in a home- and community-based care program for older people with mild impairment in Hong Kong. The program used the interRAI-Check Up instrument for needs assessment and service matching between 2017 and 2020. Each participant's cognitive performance was assessed using CPS, CPS Version 2 (CPS2), and MoCA 5-min. We performed equipercentile linking with bivariate log-linear smoothing to establish equivalent scores between the two scales. Results: 3,543 participants had valid data on both scales; 66% were female and their average age was 78.9 years (SD = 8.2). The mean scores for MoCA 5-min, CPS, and CPS2 were 18.5 (SD = 5.9), 0.7 (SD = 0.7), and 1.3 (SD = 1.1), respectively. A CPS or CPS2 score of 0 (intact cognition) corresponds to MoCA 5-min scores of 24 and 25, respectively. At the higher end, a CPS score of 3 (moderately impaired) and a CPS2 score of 5 (moderately impaired Level-2) corresponded to MoCA 5-min scores of 0 and 1, respectively. The linking functions revealed the floor and ceiling effects that exist for the different scales, with CPS and CPS2 measuring more-severe cognitive impairment while the MoCA 5-min was better suited to measure mild impairment. Conclusions: We provided score conversions between MoCA 5-min and CPS/CPS2 within a large cohort of Hong Kong older adults with mild physical or cognitive impairment. This enabled continuity in repeated assessment with different tools and improved comparability of cognitive scores generated from different tools from diverse populations and research cohorts.