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Impacts of ‘two-level’ variability on the differential power for Montreal Cognitive Assessment (MoCA) in prodromal dementia
  1. Hanna Lu1,2,
  2. Linda C W Lam1
  1. 1Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
  2. 2Department of Psychiatry, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
  1. Correspondence to Dr Hanna Lu, Department of Psychiatry, The Chinese University of Hong Kong, G/F, Multi-Centre, Tai Po Hospital, Hong Kong, China; hannalu{at}

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We read with great interest of the study defining and validating the screening accuracy of short form Montreal Cognitive Assessment (s-MoCA) in individuals with different cognitive status.1 This 5-min s-MoCA is attractive because it achieves the goal for adequate screening of cognitive impairment in an ageing population. Of particular interest, the ‘disease-specific’ versions of s-MoCA enrolling the items from full MoCA, present different classification accuracy.

It is noteworthy to postulate that the alternative items between versions of s-MoCA may due to the underlying heterogeneity driven by two-level variability. The first-level is interindividual variability due to the diagnostic classification: mild cognitive impairment (MCI) and dementia refer to a highly heterogeneous community with diverse aetiology, cognitive profiles and clinical outcomes. It is not surprising to find some commonalities given that the underlying neural basis for cognitive impairment in patients with MCI may present with similar impaired cognitive domain …

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  • Contributors HL and LCWL conceived and designed this study. HL conducted the flanker test and statistical analyses. HL drafted this manuscript, LCWL discussed and agreed to the final version of this manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.