[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-433597-105":59,"doc-detail-433597-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","recalibrating-moca-thresholds-in-taiwan-commentary-on-new-population-data","Recalibrating MoCA thresholds in Taiwan - Commentary on new population data","","Early identification of cognitive decline depends on screening tools with strong psychometric performance tailored to the target population. This commentary evaluates a Taiwanese normative study that generated age-, education-, and sex-adjusted MoCA norms from 2,310 cognitively healthy adults aged 20–98. It discusses why local cutoffs remain necessary, highlights methodological strengths such as regression-based adjustment and transparency in ceiling effects, and outlines clinical and policy implications for dementia benefit eligibility and future research.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/recalibrating-moca-thresholds-in-taiwan-commentary-on-new-population-data/433597/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/recalibrating-moca-thresholds-in-taiwan-commentary-on-new-population-data/433597.png","ImageObject",300,407,{"name":92,"@type":93},"Patrick","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why do local MoCA norms matter in Taiwan?","Question",{"text":113,"@type":114},"The original MoCA cutoff was calibrated on North American patients, making it overly stringent elsewhere. The Taiwanese data supports nonlinear effects of age and schooling and suggests lower optimal cutoffs for better identification of impairment.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What methodological strengths does the Taiwanese normative study include?",{"text":118,"@type":114},"It uses a much larger and more heterogeneous sample and models age, education, and sex simultaneously via multiple regression rather than a single education rule. The study also reports ceiling effects for each subtest and provides an Excel calculator for point-of-care scoring.",{"name":120,"@type":111,"acceptedAnswer":121},"How could the demographically adjusted MoCA cutoff affect clinical practice and policy?",{"text":122,"@type":114},"Applying a demographically adjusted cutoff could reduce false-positive referrals while maintaining sensitivity for prodromal decline. It may also inform decision-making for reimbursement pathways currently relying heavily on MMSE thresholds in Taiwan’s National Health Insurance.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},433597,1790740003,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":24,"preview_page_count":4},549758146520,"https://ap-avatar.wpscdn.com/avatar/80002397d8c0411e94?_k=1775819394049821470","J Chin MedAssoc  \nSPECIAL INVITATION  \nRecalibrating MoCA thresholds in Taiwan: Commentary on new population data  \nYu-Ling Changa,b,c,*  \naDepartment of Psychology, College of Science, National Taiwan University, Taipei, Taiwan, ROC; bDepartment of Neurology, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC; cGraduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC  \nEarly identification of cognitive decline requires screening instruments that are both psychometrically sound and populationspecific. The article, “A Normative Study of the Taiwanese Version of the Montreal Cognitive Assessment (MoCA) in Community-Dwelling Individuals in Taiwan” meets this need by generating age-, education-, and sex-adjusted norms from a sample of 2310 cognitively healthy adults aged 20 to 98 years drawn from northern, central, and southern Taiwan.1 This commentary evaluates Cheng et al’s1 key contributions and methodological rigor, highlights remaining limitations, and considers the implications for clinical practice, health-care policy, and future research.  \n1. WHY LOCAL NORMS STILL MATTER  \nSince its introduction two decades ago, the MoCA has become a mainstay for identifying mild cognitive impairment (MCI) . Compared with the Mini-Mental State Examination (MMSE), it samples executive control, visuospatial construction, and abstraction more fully, yielding higher sensitivity and detecting impairment several years earlier.2–4 It is brief, free for noncommercial clinical use, and available in >100 languages, which facilitates both bedside adoption and electronic-record integration. The original 26/30 cutoff, however, was calibrated on North American patients and proves overly stringent elsewhere. Subsequent normative efforts in the United States,5 Italy,6 Japan,7 and other countries all converged on two themes: (1) strong, nonlinear effects of age and schooling, and (2) lower optimal cutoffs ranging from 21 to 25. The present Taiwanese study confirms these patterns with a dataset two to eight times larger than prior reports, thereby increasing statistical power and external validity.  \n2. METHODOLOGICAL ASSETS  \nSeveral aspects of this normative study raise the methodological bar. First, the investigators assembled a much broader cohort than previous efforts, enrolling community dwellers and hospital attendees of both sexes, with educational attainment ranging  \n*Address correspondence. Dr. Yu-Ling Chang, Department of Psychology, College of Science, National Taiwan University, 1, Section 4, Roosevelt Road, Taipei 106, Taiwan, [ROC. E-mail address: ychang@ntu.edu.tw](ROC. E-mail address: ychang@ntu.edu.tw) (Y.-L. Chang). Conflicts of interest: The author declares that he/she has no conflicts of interest related to the subject matter or materials discussed in this article.  \nJournal of Chinese Medical Association. (2025) 88: 581-582.  \nReceived July 10, 2025; accepted July, 11, 2025.  \nCopyright © 2025, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))  \nfrom primary school to postgraduate levels, and ages spanning 20 years to nearly 100. Such heterogeneity markedly reduces the spectrum bias typical of small, highly educated convenience samples. Second, instead of the blunt “add one point if education is 12 years or less”rule, the authors applied multiple regression to model age, education, and sex simultaneously. Treating education as a continuum and incorporating interaction terms yields corrections that reflect each participant’s true demographic profile. Third, the study demonstrates commendable transparency by reporting ceiling effects for every subtest. For example, 86% of participants scored perfectly on orientation and 82% on naming, a pattern that warns clini","cbCaihFpioPzQXQY","https://ap.wps.com/l/cbCaihFpioPzQXQY","pdf",259181,"English","# Why local norms still matter\n# Methodological assets\n# Clinical implications","[{\"question\":\"Why do local MoCA norms matter in Taiwan?\",\"answer\":\"The original MoCA cutoff was calibrated on North American patients, making it overly stringent elsewhere. The Taiwanese data supports nonlinear effects of age and schooling and suggests lower optimal cutoffs for better identification of impairment.\"},{\"question\":\"What methodological strengths does the Taiwanese normative study include?\",\"answer\":\"It uses a much larger and more heterogeneous sample and models age, education, and sex simultaneously via multiple regression rather than a single education rule. The study also reports ceiling effects for each subtest and provides an Excel calculator for point-of-care scoring.\"},{\"question\":\"How could the demographically adjusted MoCA cutoff affect clinical practice and policy?\",\"answer\":\"Applying a demographically adjusted cutoff could reduce false-positive referrals while maintaining sensitivity for prodromal decline. It may also inform decision-making for reimbursement pathways currently relying heavily on MMSE thresholds in Taiwan’s National Health Insurance.\"}]","Recalibrating MoCA thresholds in Taiwan - Commentary on new population data | PDF",1790664749]