Abstract：
UNASSIGNED: In the era of disease-modifying therapies, empowering the clinical neuropsychologist\'s toolkit for timely identification of mild cognitive impairment (MCI) is crucial.
UNASSIGNED: Here we examine the clinimetric properties of the Montreal Cognitive Assessment (MoCA) for the early diagnosis of MCI due to Alzheimer\'s disease (MCI-AD).
UNASSIGNED: Data from 48 patients with MCI-AD and 47 healthy controls were retrospectively analyzed. Raw MoCA scores were corrected according to the conventional Nasreddine\'s 1-point correction and demographic adjustments derived from three normative studies. Optimal cutoffs were determined while previously established cutoffs were diagnostically reevaluated.
UNASSIGNED: The original Nasreddine\'s cutoff of 26 and normative cutoffs (non-parametric outer tolerance limit on the 5th percentile of demographically-adjusted score distributions) were overly imbalanced in terms of Sensitivity (Se) and Specificity (Sp). The optimal cutoff for Nasreddine\'s adjustment showed adequate clinimetric properties (≤23.50, Se = 0.75, Sp = 0.70). However, the optimal cutoff for Santangelo\'s adjustment (≤22.85, Se = 0.65, Sp = 0.87) proved to be the most effective for both screening and diagnostic purposes according to Larner\'s metrics. The results of post-probability analyses revealed that an individual testing positive using Santangelo\'s adjustment combined with a cutoff of 22.85 would have 84% post-test probability of receiving a diagnosis of MCI-AD (LR+ = 5.06).
UNASSIGNED: We found a common (mal)practice of bypassing the applicability of normative cutoffs in diagnosis-oriented clinical practice. In this study, we identified optimal cutoffs for MoCA to be allocated in secondary care settings for supporting MCI-AD diagnosis. Methodological and psychometric issues are discussed.
UNASSIGNED: Here we examine the clinimetric properties of the Montreal Cognitive Assessment (MoCA) for the early diagnosis of MCI due to Alzheimer\'s disease (MCI-AD).
UNASSIGNED: Data from 48 patients with MCI-AD and 47 healthy controls were retrospectively analyzed. Raw MoCA scores were corrected according to the conventional Nasreddine\'s 1-point correction and demographic adjustments derived from three normative studies. Optimal cutoffs were determined while previously established cutoffs were diagnostically reevaluated.
UNASSIGNED: The original Nasreddine\'s cutoff of 26 and normative cutoffs (non-parametric outer tolerance limit on the 5th percentile of demographically-adjusted score distributions) were overly imbalanced in terms of Sensitivity (Se) and Specificity (Sp). The optimal cutoff for Nasreddine\'s adjustment showed adequate clinimetric properties (≤23.50, Se = 0.75, Sp = 0.70). However, the optimal cutoff for Santangelo\'s adjustment (≤22.85, Se = 0.65, Sp = 0.87) proved to be the most effective for both screening and diagnostic purposes according to Larner\'s metrics. The results of post-probability analyses revealed that an individual testing positive using Santangelo\'s adjustment combined with a cutoff of 22.85 would have 84% post-test probability of receiving a diagnosis of MCI-AD (LR+ = 5.06).
UNASSIGNED: We found a common (mal)practice of bypassing the applicability of normative cutoffs in diagnosis-oriented clinical practice. In this study, we identified optimal cutoffs for MoCA to be allocated in secondary care settings for supporting MCI-AD diagnosis. Methodological and psychometric issues are discussed.
摘要：
■在疾病修饰疗法的时代，授权临床神经心理学家的工具包及时识别轻度认知障碍（MCI）是至关重要的。
■在这里，我们研究了蒙特利尔认知评估（MoCA）的临床特性，用于早期诊断由于阿尔茨海默病（MCI-AD）引起的MCI。
■对48例MCI-AD患者和47例健康对照者的数据进行回顾性分析。根据常规Nasreddine的1分校正和来自三项规范性研究的人口统计学调整对原始MoCA评分进行校正。确定最佳截止值，同时对先前建立的截止值进行诊断重新评估。
■Nasreddine的原始截止值26和标准截止值（人口统计学调整分数分布的第5百分位数的非参数外部公差极限）在灵敏度（Se）和特异性（Sp）方面过于不平衡。Nasreddine调整的最佳截止值显示出足够的临床特性（≤23.50，Se=0.75，Sp=0.70）。然而,根据Larner的指标，Santangelo调整的最佳截止值（≤22.85，Se=0.65，Sp=0.87）被证明对筛查和诊断目的最有效。后概率分析的结果表明，使用Santangelo的校正结合22.85的截止值进行阳性测试的个体在测试后接受MCI-AD诊断的概率为84％（LR=5.06）。
■我们发现了一种在以诊断为导向的临床实践中绕过规范截止值适用性的常见（错误）实践。在这项研究中,我们确定了将MoCA分配到二级护理机构以支持MCI-AD诊断的最佳截止值.讨论了方法论和心理测量学问题。
■在这里，我们研究了蒙特利尔认知评估（MoCA）的临床特性，用于早期诊断由于阿尔茨海默病（MCI-AD）引起的MCI。
■对48例MCI-AD患者和47例健康对照者的数据进行回顾性分析。根据常规Nasreddine的1分校正和来自三项规范性研究的人口统计学调整对原始MoCA评分进行校正。确定最佳截止值，同时对先前建立的截止值进行诊断重新评估。
■Nasreddine的原始截止值26和标准截止值（人口统计学调整分数分布的第5百分位数的非参数外部公差极限）在灵敏度（Se）和特异性（Sp）方面过于不平衡。Nasreddine调整的最佳截止值显示出足够的临床特性（≤23.50，Se=0.75，Sp=0.70）。然而,根据Larner的指标，Santangelo调整的最佳截止值（≤22.85，Se=0.65，Sp=0.87）被证明对筛查和诊断目的最有效。后概率分析的结果表明，使用Santangelo的校正结合22.85的截止值进行阳性测试的个体在测试后接受MCI-AD诊断的概率为84％（LR=5.06）。
■我们发现了一种在以诊断为导向的临床实践中绕过规范截止值适用性的常见（错误）实践。在这项研究中,我们确定了将MoCA分配到二级护理机构以支持MCI-AD诊断的最佳截止值.讨论了方法论和心理测量学问题。
