Montreal Cognitive Assessment (MoCA)

The Montreal Cognitive Assessment (MoCA) takes approximately 10 minutes to

administer and was designed to detect mild cognitive impairment in elders scoring in the normal

range on the MMSE. Thirty items assessing multiple cognitive domains are contained in the

MoCA: short-term memory (5 points); visuospatial abilities via clock drawing (3 points), and a

cube copy task (1 point); executive functioning via an adaptation of Trail Making Test Part B (1

point), phonemic fluency (1 point), and verbal abstraction (2 points); attention, concentration,

and working memory via target detection (1 point), serial subtraction (3 points), digits forward (1

point), and digits backward (1 point); language via confrontation naming with low-familiarity

animals (3 points), and repetition of complex sentences (2 points); and orientation to time and

place (6 points). The MoCA is scored by obtaining an item total and the authors recommend a

clinical cutoff score of 26.

Domains assessed:

The MoCA assesses several cognitive domains:

 The short-term memory recall task (5 points) involves two learning trials of five nouns and

delayed recall after approximately five minutes.

 Visuospatial abilities are assessed using a clock-drawing task (3 points) and a three-

dimensional cube copy (1 point).

 Multiple aspects of executive functions are assessed using an alternation task adapted from

the trail-making B task (1 point), a phonemic fluency task (1 point), and a two-item verbal

abstraction task (2 points).

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 Attention, concentration, and working memory are evaluated using a sustained attention task

(target detection using tapping; 1 point), a serial subtraction task (3 points), and digits

forward and backward (1 point each).

 Language is assessed using a three-item confrontation naming task with low-familiarity

animals (lion, camel, rhinoceros; 3 points), repetition of two syntactically complex sentences

(2 points), and the aforementioned fluency task.

 Finally, orientation to time and place is evaluated by asking the subject for the date and the

city in which the test is occurring (6 points)

Items:

 Alternating Trail Making

 Visuoconstructional Skills(cube)

 Visuoconstructional Skills (Clock)

 Naming:

 Memory

 Attention

 Sentence repetition

 Verbal fluency

 Abstraction

 Delayed recall

 Orientation

Item analysis reveals that the MoCA can discriminate reliably between normal subjects,

participants with MCI, and those with dementia (Nasreddine et al., 2005). The three groups

separate on all tasks except digit span, sustained attention, and the calculation task, on which

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those with MCI and normal subjects do not differ. In contrast, those with Alzheimer's disease

and MCI perform similarly poorly on the sentence repetition task. While sensitivity and

specificity vary somewhat across studies, using a cut-off score of 26, the MoCA consistently has

much higher sensitivity in detecting MCI and Alzheimer's disease than the MMSE. In contrast,

the MMSE has excellent specificity (approaching 100%), with the MoCA much lower (ranges

from 35% to 87%)

Advantages:

The MoCA has a number of advantages as a screening test for memory loss and

dementia. First, the test and instructions are freely available. Second, it has clear instructions and

scoring. Third, it has been translated into more than 45 languages, many with alternate versions

and versions specifically for blind patients. Fourth, it covers a variety of cognitive domains. Its

main limitations are that it is still relatively new and normative data are limited. Nonetheless, it

is rapidly becoming the standard mental status screening test of many clinics.

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References:

Lichtenberg, P. A. (Ed.). (1999). Wiley series on adulthood and aging. Handbook of assessment

in clinical gerontology.Hoboken, NJ, US: John Wiley & Sons Inc

Nasreddine, Ziad S.; Phillips, Natalie A.; Bédirian, Valérie; Charbonneau, Simon; Whitehead,

Victor; Collin, Isabelle; Cummings, Jeffrey L.; Chertkow, Howard (2005-04-01). "The

Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive

impairment". Journal of the American Geriatrics Society. 53 (4): 695–699.

Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL,

Chertkow H (2005). "The Montreal Cognitive Assessment, MoCA: a brief screening tool

for mild cognitive impairment". J Am Geriatr Soc. 53 (4): 695–9. doi: 10.1111/j.1532-

5415.2005.53221.

Psychiatric rating scales". Handbook of Clinical Neurology. 106: 227–237. 2012-01-

01. doi:10.1016/B978-0-444-52002-9.00013-9.