Montreal Cognitive Assessment (MoCA)

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(Transient Ischemic Attacks (TIAs), Stroke, Diabetes, Sedentary Lifestyle, smoking and
alcohol comsumtion)
*to identify/ Interpretation potential cognitive impairments among employees or simply
promote cognitive wellness?
* aseline and Follow-Up: If you're using the MOCA test as a cognitive wellness initiative,
consider conducting baseline assessments to track changes over time. Regular follow-up
assessments can help identify any shifts in cognitive performance.

Developed by dr. Ziad Nasreddine and his colleagues at the Montreal Neurological Institute in
1996 and has gained popularity as a quick and effective way to detect mild cognitive impairment
(MCI) and early signs of dementia, particularly Alzheimer's disease.

The Montreal Cognitive Assessment (MoCA) is a widely used cognitive screening tool designed
to assess various cognitive functions, including memory, attention, language, and visuospatial
abilities.

The MoCA is regularly used by physicians nurses, primary care and specialty physicians,
occupational therapists, and others.

MoCA is intended to provide a more sensitive evaluation of cognitive decline compared to

other common screening tests, such as the Mini-Mental State Examination (MMSE). It is
particularly useful for detecting cognitive impairments that might not be captured by the
MMSE.

The Montreal Cognitive Assessment (MoCA) test consists of several tasks that assess various
cognitive domains. Here's a breakdown of the tasks involved in the MoCA assessment:

Visuospatial and Executive Functioning:

Alternating Trail Making: Connecting alternating numbers and letters in order.
Visuospatial Abilities: Copying a complex drawing that includes overlapping pentagons.

Naming:
Naming Objects: Naming pictures of different animals.

Memory:
Short-Term Memory: Remembering and repeating a list of five words.
Long-Term Memory: Recalling the five words after a short delay.

Attention:
Sustained Attention: Listening to a list of digits and repeating them in reverse order.
Serial Subtractions: Subtracting seven from a given number and continuing the sequence.

Language:
Repetition: Repeating a complex phrase.
Verbal Fluency: Generating as many words as possible within a specific category (e.g., animals)
in one minute.
Sentence Repetition: Repeating a sentence with complex syntax.

Abstraction:
Similarities: Identifying commonalities between pairs of words (e.g., orange and banana both
being fruits).
Delayed Recall:
Recalling the five words from earlier in the test after completing other tasks.

Orientation:
Time Orientation: Answering questions about the current date and day of the week.
Place Orientation: Identifying the location of the testing session.

The test takes about 10 to 15 minutes to complete and is scored out of 30 points. A score of 26 or
above out of 30 is generally considered normal, while lower scores might indicate the need for
further cognitive assessment.

Step by step MOCA assessment

A. VISUOSPATIAL/EKSEKUTIF
1. Draw line starting from number to alfabhet sequentially as an example.
Start at here. [Points to (1)] and draws a line from 1 then to A then to 2 and so
on. ends here [points to (E)]. " Score: Give one point if the participant draws the
following patterns: 1–A– 2 – B - 3 – C - 4 – D - 5 – E, without making intersecting
lines. Any errors that are not corrected immediately will be graded from 0.

2. Following instructions, (while points to the cube) : "Copy this image as closely as
possible, in parts blank below".
Score : One point correctly allocated to the picture executed.
• Drawings must be three-dimensional
• All lines are drawn
• No lines are added or repeated.
• The results of relatively parallel lines with the same length (prism rectangle
received) point A is not set if false one of the above criteria is not met.

3. Indicate the third room/section (on the right) and give the following instructions:
"Draw a clock showing at 11:10 am complete with numbers. ".
Score: Give one point for each of the following three criteria:
-Contour (1 point): Draw a clock that should be a circle (small error may be tolerated,
e.g. slight imperfections in closure circle);
-Numbers (1 point): All required clock numbers and no numbers addition; the
numbers must be in the correct order and appropriate placement; Roman numerals are
acceptable; number can be placed outside the circle contour ;
-Hands (1 point): There should be two hands indicating which time to be precise, the
hour hand should be markedly shorter than the minute side; and the base must
 centered in the center of the circle. Point value will not be awarded if any of the three
criteria above not fulfilled.

4. MEMORY
Starting from the image on the left, pointing pictures one by one while saying “Tell
me what animal, This?"
Score: One point for each picture that is answered correctly (1) Camel (2) Rhinoceros
(3) Lion

5. ATTENTION
Read list of words, subject must repeat them. Do 2 trials. Do a recall after 5 minutes.
Reads the list of 5 words providedsequentially with a one-second delay from word
one to next, then give the following instructions: “This is a test memory. I will read
you a list of words that you will have to remember now and then. Listen carefully.
When I'm done, repeat the words you remember". Check back the words that are
repeated participants (patients).

If the participant indicated that he had finished or can't remember any further words,
go through the list said a second time with the following instructions: "I will134 read
the same list a second time. try to remember and say back as many words as you can
can, including the words you said the first time” Put a tick (√) in the column provided
for each correct word. At the end of the second test, inform the participant that he will
asked to recall the words again by saying, "I will asking you to memorize the words
again at the end of the test."
Score: No points are awarded for the first and second tests.

6. ATTENTION
Forward Digit Span (Read a list of numbers): Give the following instructions: "I will
say some numbers and when I'm done, repeat exactly those numbers as I have
mentioned". Read the first number sequence with flat intonation and one second
pause between numbers.

Backward Digit Span:

Give the following instructions: "Now I will say a few more numbers, but when I'm
done, you should repeated to me in reverse/reverse order" Read sequence the second
number with a flat intonation and a one second pause between each number.
Score: Give one point for each correct order. (example: the correct answer for the
order from behind is 2-4-7).

Letter/Alphabet List:
reads the list of alphabetical order on on constant speed, after giving the following
instructions: "I will read the order of letters. Every time I say the letter A, knock it
your hand once. If I say a different letter, don't
make a beat".
Score: Give one point if the error occurs at most once (error is tapping on the wrong
letter or failure to tap on letter A)
 7s Series (Deduction of Number 7)
Administration: the examiner gives the following instructions: "Now, I'm going to ask
you to do the math, sequential subtraction with the number 7, starting at 100, and then
working your way down by seven from your answer until I tell you to stop" Repeat
this instruction twice if necessary.
Score: This sub test has a maximum value of 3 points if the correct answer is > 4;
Give 2 points if 2 or 3 answers are correct; value 1 point for 1 answer Correct; and 0
(zero) if none of the answers are correct. As an example, a participant can answer
"92-85 - 78-71 - 64" where "92" is not true, but all subsequent numbers will be
subtracted correctly. This is one of the errors and the item will be given a score of 3.

7. LANGUAGE
Repeat sentences
Gives the following instructions: "I will read sentences.
Repeat exactly what I said it [pause]: I only know that john is the one to help today"
(After response) continue in the second sentence, with the instruction: "Now I will
read another sentence. Repeat after me, just like me say it [pause]: The cat always hid
under the coucht when the dogs were in the room.
Score: Give 1 point for each sentence correctly repeated.
Repetitions must match exactly. Be on the lookout for errors because omissions (e.g.,
by ignoring "when", "this") and substitutions/ additions (for example, "swept the floor
today;" replaces or change the plural form, etc.)

Gives the following instructions: "Say as many words as possible that start with the
particular letter i will tell you in a moment. you can say what any word you want,
except for Nouns (such as people's names or animals, etc.), numbers, or words that
start with the sound that ame but has a different ending. I will tell 136 you to stop
after one minute. Are you ready? [pause] Now, say as many words that start with a
letter F. [time for 60] sec. Stop.
Score: Give one point if the participant comes up with 11 words or
more in 60 seconds.

8. ABSTRACTION
The examiner asks the subject to explain what similarities that each word pair will
have mentioned, starting with the example: "Tell me what similarities between
bananas and oranges?". If the subject's answers are given inaccurately, repeat the
previous instructions with says: "Give another resemblance". If the participant doesn't
gave an appropriate response (fruit), the examiner said, "Yes, both are fruit" Don't
give any extra clues or clarification After the trial or example, give the next
instruction: "Now, State the similarity between a train and a bicycle". Following are
the responses, then for the second question, instruct: "Next state resemblance between
a watch and a ruler". Examiners are prohibited provide additional clues or keywords.
Score: Only the last two items are scored. Give 1 point for each pair to answer the
question correctly.
The following responses are acceptable: Train-bike = means of transport,
travel means; Watch-ruler = measuring instrument, used for measure.
 The following responses are unacceptable: Train-bike = they have
wheel; Ruler-watch = they have numbers.

9. DELAYED RECALL
The examiner gives the following instructions: "I will read a few words to you
beforehand, your assignment is to remember the words that I have mentioned and
then repeating those words again.” Make a check mark (√) for every word that can be
remembered and mentioned spontaneously without cue.
Score: Give 1 point for each word that is successfully memorized and in
state it correctly without hints or keywords.

10. ORIENTATION
Examiner gives instructions "Say date what is it/today". If the participant does not
give an answer complete, then immediately proceed with the instructions: "Tell me
(month, year and day)” Then say: “Now tell me where are we now (place, and city).
Score: Give one point for each item/question answered with Correct. Participants
must state the date and name of the place with appropriate (name of hospital, clinic,
office). Points/grades are not awarded if participant made a mistake in answering the
question.

TOTAL SCORES: Add up all the sub scores listed on the right hand side.
Add one point for participants who have a background less than 12 years of
formal education. Maximum score generated is 30, for a total score > 26 is
normal (no disturbance).