Montreal Cognitive Assessment Testing (MoCA)

Primer

MoCA

MoCA Instructions MoCA (7.1) Download (v7.2, v7.3, v8.1, v8.2, v8.3)

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] Download TILDA Norms (PDF)

Resources

References

1) Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., ... & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699.
2) Kenny, R. A., Coen, R. F., Frewen, J., Donoghue, O. A., Cronin, H., & Savva, G. M. (2013). Normative values of cognitive and physical function in older adults: findings from the Irish Longitudinal Study on Ageing. Journal of the American Geriatrics Society, 61, S279-S290.