NAME: Sonia
MONTREAL COGNITIVE ASSESSMENT (MOCA) Education: 3AP°Date of birth: 24 I 1274
Sex: P
DATE:23-10- 21I
VISUOSPATIAL/ EXECUTIVE Copy Draw CLOCK (Ten past eleven) POINTS
cube (3 pofnts)
End
Begin
2
[11 41 41
Contour Numbers Hands 45
NAMING
M
MEMORY Read list of words,
3/3
subject FACE VELVET CHURCH
must repeat them. Do 2 trials. DAISY RED
Do a recall after 5 minutes. 1st trial
No
2nd trial
Points
ATTENTION Read list of digits (1 digit/ sec.). Subject has to repeat them in the forward order
Subject has to repeat them in the backward order
]218 5 4
Read list of letters. The subject must ] 7 42
tap with his hand at each letter A. No points if 22errors
Serial 7 subtraction starting at 100
M93
FBACMNAAJKLBAFAKDEAAAJAMOFAAB
86 M79 M65
LANGUAGE
4 Or 5corect subtractions: 3 pts, 2 orT 3 CorTect: 2 pts, 1 correct: 1 pt, o comect: 0 pt
Repeat: Ionly know that John is the one to help today.
The cat always hid under the couch when
3/3
dogs were in the room. ]
Fhuency / Name maximum number of words in one
minute that begin with the letter F N
/2
ABSTRACTION (N21 words)
Stmflartty between e.g. banana -orange =
fruit tratn -bicycle watch ruler
DELAYED RECALL Has to recall words
FACE
-
/2
VELVET CHURCH DAISY RED Points for
WITH NO CUE
M UNCUED
recall only
/5
Optional Category cue
Multiple choice cue
ORIENTATION [Date Month
Year Day [Place Mcity 6/6
OZ.Nasreddine MD Version November 7, 2004
Normal2 26/30 TOTAL
www.mocatest.org 28_/30|
Add 1 point if s 12 yr edu
