# Montreal Cognitive Assessment Hearing Impairment (MoCA-H) in Brazilian Portuguese: criterion and construct validity

## TL;DR

This study evaluates the validity of the MoCA-H cognitive assessment tool for elderly Brazilians with hearing loss, finding it reliable for detecting mild cognitive decline but needing improvement in construct validity.

## Contribution

The study provides the first validation of the MoCA-H in Brazilian Portuguese for elderly individuals with hearing impairment.

## Key findings

- MoCA-H showed good criterion validity, with significant differences in cognitive domains between groups with and without cognitive decline.
- Construct validity was weak and non-significant when comparing MoCA-H and MMSE scores.
- The MoCA-H is a reliable tool for mild cognitive decline screening but requires further validation with alternative protocols.

## Abstract

To find evidence of criterion and construct validity for the Montreal Cognitive Assessment Hearing Impairment (MoCA-H) protocol in Brazilian Portuguese.

The sample consisted of 70 elderly people divided into two groups: Group 1-50 subjects with hearing loss and no cognitive decline; Group 2-20 subjects with hearing loss and cognitive decline. Criterion validity was obtained by comparing Group 1 and 2 considering the overall score and the eight domains assessed in the MoCA-H. The data were analyzed using the Mann-Whitney U-test and Student's T-test, respecting the characteristics of the data collected. To verify construct validity, the correlation between the total scores of the Mini-Mental State Examination (MMSE) and the MoCA-H obtained by Group 2 was analyzed. Spearman's Correlation Test was used for this purpose.

The analysis of criterion validity showed a difference between the groups with and without decline in naming, attention, language, abstraction, memory and delayed recall skills, as well as the MoCA-H total score, indicating significantly higher performance of Group 1. The construct validity correlation analysis was weak and non-significant (Rho=0.384; p=0.095) between the MoCA-H and MMSE scores.

The MoCA-H protocol showed good criterion validity for this specific population, making it a reliable tool for screening mild cognitive decline. However, it did not show satisfactory construct validity, indicating the need for further studies with this instrument using another protocol as a reference.

Buscar evidências de validade de critério e de construto para o protocolo Montreal Cognitive Assessment Hearing Impairment (MoCA-H) no Português Brasileiro.

Participaram da amostra 70 idosos distribuídos em dois grupos: Grupo 1-50 sujeitos com perda auditiva e sem declínio cognitivo; Grupo 2-20 sujeitos com perda auditiva e com declínio cognitivo. A validade de critério foi obtida mediante comparação dos Grupos 1 e 2, considerando o escore geral e os oito domínios avaliados no MoCA-H. Os dados foram analisados com o teste U de Mann-Whitney e teste T de Student, respeitando as características dos dados coletados. Para verificação da validade de construto analisou-se a correlação entre os escores totais do Mini Exame do Estado Mental (MEEM) e do MoCA-H obtidos pelo Grupo 2. Para tanto, utilizou-se o Teste de Correlação de Spearman.

A análise da validade de critério mostrou diferença entre os grupos com e sem declínio nas habilidades nomeação, atenção, linguagem, abstração, memória e evocação tardia, além do escore total do MoCA-H, indicando desempenho significativamente superior nos sujeitos do Grupo 1. Na análise da validade de construto, foi observado correlação fraca e sem significância (Rho=0,384; p=0,095) entre os escores do MoCA-H e do MEEM.

O protocolo MoCA-H apresentou boa validade de critério para esta população específica, tornando-se uma ferramenta confiável para a triagem de declínio cognitivo leve. No entanto, não apresentou validade de construto satisfatória, indicando a necessidade de mais estudos com o referido instrumento utilizando outro protocolo como referência.