- Last edited on April 30, 2020
This is an old revision of the document!
Montreal Cognitive Assessment Testing (MoCA)
Primer
The Montreal Cognitive Assessment Testing (MoCA) is a brief cognitive screening tool with high sensitivity and specificity for detecting Mild Neurocognitive Disorder / Mild Cognitive Impairment (MCI) (also known as mild cognitive impairment, or MCI). The MoCA is particularly useful for detecting cognitive changes in those with higher levels of education, or where cognition the primary clinical concern.
Indications
The MoCA is best used for screening for mild neurocognitive disorder (i.e. - mild cognitive impairment).
Components and Scoring
MoCA Cognitive Domains and Neuroanatomy
Category | Test | Cognitive domain | Neuroanatomical region |
---|---|---|---|
Visuospatial/Executive | Trails | Executive function | Dorsolateral prefrontal cortex |
Visuospatial/Executive | Cube | • Executive function • Visual/spatial perception, construction praxis | • Dorsolateral prefrontal cortex • Right parietal lobe |
Visuospatial/Executive | Clock | • Constructional praxis • Executive function | • Right parietal lobe • Dorsolateral prefrontal cortex |
Naming | Animals | • Semantic knowledge • Vocalization and articulation | • Anterior temporal lobes (bilateral) • Broca’s area and insular cortex |
Memory | 5 word repeat | Working memory | Anterior temporal lobes (bilateral) |
Attention | Digit list | Attention/vigilance | Dorsolateral prefrontal cortex |
Attention | Tapping | Response inhibition | Orbitofrontal cortex |
Attention | Serial 7s | Working memory/attention/calculation | Dorsolateral prefrontal cortex, left parietal lobe |
Language | Sentence repeat | Working memory/executive function | Dorsolateral prefrontal cortex |
Language | Fluency (F-words in 1 minute) | Working memory/executive function | Dorsolateral prefrontal cortex |
Abstraction | Similarities | Abstraction | Dorsolateral prefrontal cortex |
Delayed Recall | 5 word delayed recall | Memory | Hippocampus |
Orientation | Date, time, place | Memory | Hippocampus |
Scoring Tips
- F-word fluency: Proper names (e.g. - Frank, Fred, etc.) are not allowed. Words generated from a single stem are also not allowed (e.g. - pot, pots, potter, potted)
- Delayed-recall: If the patient can recall words with multiple choice or category cues, then it memories were stored in the hippocampus, but unable to be retrieved. This would mean a frontal lobe deficit, more commonly seen in vascular dementia or Parkinson’s dementia.
Norms
Suggested cut-off scores by the creator of the MoCA, are as follows:[1]
MoCA Cut-off Scores
Nasreddine, Ziad S., et al. MoCA: a brief screening tool for mild cognitive impairment. J Am Geri 53.4 (2005): 695-699.Normal Controls | Mild Cognitive Impairment | Alzheimer's Disease | |
---|---|---|---|
N | 90 | 94 | 93 |
Average score | 27.4 | 22.1 | 16.2 |
Standard deviation | 2.2 | 3.1 | 2.8 |
Range | 25.2 | 19.0-25.2 | 11.4-21.0 |
Suggested cut-off score | ≥ 26 | < 26 | < 26 |
Other
Other Data Sets
Newer normative (age and education) MMSE and MoCA datasets from The Irish Longitudinal Study on Ageing (TILDA), based on a geriatric population, was also recently published in 2013.[2] |