Improving Cognitive Assessment Utility in Community Settings: Stratified Normative Data and Age-Specific Score Conversions between the MoCA-J and MMSE in Community-Dwelling Older Adults

Improving Cognitive Assessment Utility in Community Settings: Stratified Normative Data and Age-Specific Score Conversions between the MoCA-J and MMSE in Community-Dwelling Older Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Improving Cognitive Assessment Utility in Community Settings: Stratified Normative Data and Age-Specific Score Conversions between the MoCA-J and MMSE in Community-Dwelling Older Adults Kitago Moe, Ogawa Susumu, Yamashiro Daichi, Kobayashi Momoko, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7504458/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Cognitive tests such as the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) are widely used to evaluate cognitive function. Given the various constraints on cognitive assessment in community settings, score conversion between the MoCA and MMSE has gained attention as a means of maximizing information while minimizing burden. With rapid population aging, scalable and valid screening is critical for public health, dementia prevention, and resource allocation. When evaluating community-dwelling older adults, demographic variables, including age, sex, and educational attainment, must be considered. However, stratified normative data remain scarce, and, to our knowledge, no study has yet provided age-stratified score conversions between these two tests. Methods We analyzed pooled data from 3,565 older adults across three population-based cohorts in Japan, representing suburban, mountainous, and metropolitan regions, and encompassing diverse medical and educational backgrounds. We developed stratified normative data for the Japanese versions of the Montreal Cognitive Assessment (MoCA-J) and the Mini-Mental State Examination (MMSE). We then constructed bidirectional score-conversion tables using equipercentile equating with log-linear smoothing, which allowed us to evaluate scores across age, sex, and educational attainment. Results We developed stratified normative data and equipercentile-based score conversion tables between the MoCA-J and MMSE in community-dwelling older adults. The MoCA-J exhibited greater variability and a stronger negative correlation with age than the MMSE. Score conversion differed notably by age group, with MMSE scores displaying a ceiling effect. For example, a MoCA-J score of 22 corresponded to an MMSE score of 27. Incorporating age-specific conversions enhanced cross-tool comparability and improved interpretability across demographic strata in both clinical and research contexts. Conclusions The association between MoCA-J and MMSE scores varied according to demographic factors. Our findings highlight the limitations of applying a single clinical cut-off and support the use of stratified normative data and age-specific conversion tables to improve score interpretation. In community-based screening settings, such tools may enhance specificity, reduce misclassification, and support tailored follow-up. Stratified norms and age-specific conversions can be integrated into community screening, primary care, and municipal health programs through look-up tables or calculator tools. Cognitive function Cognitive assessment Normative data Score conversion MoCA MMSE Community-dwelling older adults Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 18 Nov, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers invited by journal 10 Nov, 2025 Editor assigned by journal 05 Nov, 2025 Editor invited by journal 15 Oct, 2025 Submission checks completed at journal 14 Oct, 2025 First submitted to journal 14 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7504458","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":546704971,"identity":"e5376e5b-9237-4c7e-b5ea-2d77b3c1033e","order_by":0,"name":"Kitago 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Community-Dwelling Older Adults\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cognitive function, Cognitive assessment, Normative data, Score conversion, MoCA, MMSE, Community-dwelling older adults","lastPublishedDoi":"10.21203/rs.3.rs-7504458/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7504458/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCognitive tests such as the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) are widely used to evaluate cognitive function. Given the various constraints on cognitive assessment in community settings, score conversion between the MoCA and MMSE has gained attention as a means of maximizing information while minimizing burden. With rapid population aging, scalable and valid screening is critical for public health, dementia prevention, and resource allocation. When evaluating community-dwelling older adults, demographic variables, including age, sex, and educational attainment, must be considered. However, stratified normative data remain scarce, and, to our knowledge, no study has yet provided age-stratified score conversions between these two tests.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe analyzed pooled data from 3,565 older adults across three population-based cohorts in Japan, representing suburban, mountainous, and metropolitan regions, and encompassing diverse medical and educational backgrounds. We developed stratified normative data for the Japanese versions of the Montreal Cognitive Assessment (MoCA-J) and the Mini-Mental State Examination (MMSE). We then constructed bidirectional score-conversion tables using equipercentile equating with log-linear smoothing, which allowed us to evaluate scores across age, sex, and educational attainment.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eWe developed stratified normative data and equipercentile-based score conversion tables between the MoCA-J and MMSE in community-dwelling older adults. The MoCA-J exhibited greater variability and a stronger negative correlation with age than the MMSE. Score conversion differed notably by age group, with MMSE scores displaying a ceiling effect. For example, a MoCA-J score of 22 corresponded to an MMSE score of 27. Incorporating age-specific conversions enhanced cross-tool comparability and improved interpretability across demographic strata in both clinical and research contexts.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe association between MoCA-J and MMSE scores varied according to demographic factors. Our findings highlight the limitations of applying a single clinical cut-off and support the use of stratified normative data and age-specific conversion tables to improve score interpretation. In community-based screening settings, such tools may enhance specificity, reduce misclassification, and support tailored follow-up. Stratified norms and age-specific conversions can be integrated into community screening, primary care, and municipal health programs through look-up tables or calculator tools.\u003c/p\u003e","manuscriptTitle":"Improving Cognitive Assessment Utility in Community Settings: Stratified Normative Data and Age-Specific Score Conversions between the MoCA-J and MMSE in Community-Dwelling Older Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 10:57:10","doi":"10.21203/rs.3.rs-7504458/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-18T06:06:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97250917576004582543603235026729594325","date":"2025-11-18T04:54:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-10T10:48:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-05T06:05:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-15T10:57:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-14T10:58:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-10-14T10:54:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d2c1d3d-ec66-404e-b341-01b58ffac6b6","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-19T10:57:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 10:57:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7504458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7504458","identity":"rs-7504458","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}