Linguistic and cultural adaptation of the Montreal Cognitive Assessment (MoCA) version 8 for the Tamil-speaking population in India

BACKGROUND: Cognitive screening for Tamil-speaking populations is constrained by a shortage of linguistically appropriate tools. The previously available Montreal Cognitive Assessment (MoCA) version 7 did not account for Tamil diglossia, limiting its use among Indian Tamil speakers. This study aimed to linguistically and culturally adapt the parallel forms MoCA 8.1, 8.2, and 8.3 into Indian Tamil and conduct pilot testing. METHODS: Three phases were conducted: forward and back translation with MoCA Institute approval; pilot testing for linguistic clarity; and secondary pilot testing with 139 participants (106 healthy controls and 33 with clinician-diagnosed Mild Cognitive Impairment or Dementia). Unadjusted analyses showed lower clinical group scores; however, after controlling for age, most differences were non-significant, except in the Language domain. Several tasks appeared education-sensitive, indicating misclassification risk. CONCLUSIONS: The adapted Tamil MoCA versions demonstrate preliminary feasibility and cultural relevance, but validation with larger, age-matched samples is needed to establish normative data, education-based stratification, and other psychometric properties.