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cognitive-testing:moca [on March 23, 2020]
cognitive-testing:moca [on December 17, 2021] (current)
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-====== Montreal Cognitive Assessment ​Testing ​(MoCA) ======+~~META: 
 +description abstract = The MoCA is a cognitive test used for screening mild cognitive impairment.  
 +~~ 
 +====== Montreal Cognitive Assessment (MoCA) ====== 
 +{{INLINETOC}}
 ===== Primer ===== ===== Primer =====
-<​WRAP ​right 400px+<​WRAP ​group
-<panel type="​info"​ title="​MoCA"​ no-body="​true">​ +<​WRAP ​twothirds column
-| <button type="​info"​ icon="​fa fa-file"​ size="​sm">​{{ ::​moca_instructions.pdf |MoCA Instructions}}</​button> ​                               | <button type="​success"​ icon="​fa fa-download"​ size="​sm">​{{ :​moca-test-english_7_1.pdf |MoCA (7.1) Download}}</​button>​ ({{:​moca-test-english_7.2.pdf |v7.2}}, {{ :​moca-test-english_7_3_june_13.pdf |v7.3}}, {{ :​moca-8.1-english-test-2018-03.pdf |v8.1}}, {{ :​moca-8.2-english-test-2018-02.pdf |v8.2}}, {{ :​moca-8.3-english-test-2018-04.pdf |v8.3}}) ​ | +The **Montreal Cognitive Assessment (MoCA)** is a brief cognitive screening ​test with high sensitivity and specificity for detecting [[cl:​3-mild-neurocog-disorder]]. The MoCA is particularly useful for detecting cognitive changes in those with higher levels of education, or where mild cognitive changes are the primary clinical concern.
-</​panel>​ +
-</WRAP> +
-The **Montreal Cognitive Assessment ​Testing** ​(MoCA) is a brief cognitive screening ​tool with high sensitivity and specificity for detecting [[cl:​3-mild-neurocog-disorder]] ​(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 [[cl:​3-mild-neurocog-disorder|mild neurocognitive disorder]] (i.e. - mild cognitive impairment). +
  
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 </​script>​ </​script>​
 </​HTML>​ </​HTML>​
-===== Components and Scoring ===== 
  
-<panel title="​MoCA ​Cognitive Domains and Neuroanatomy" no-body="​true">​ + 
-^ Category ​               ^ Test                           ^ Cognitive domain ​                                                         ^ Neuroanatomical region ​                                                     ^ +</​WRAP>​ 
-^ Visuospatial/​Executive  ​Trails ​                        Executive function ​                                                       | Dorsolateral prefrontal cortex ​                                             | +<WRAP third column>​ 
-^ Visuospatial/Executive ​ | Cube                           | • Executive function \\ • Visual/​spatial perception, construction praxis ​ | • Dorsolateral prefrontal cortex \\ • Right parietal lobe                   +<​panel ​type="​info" ​title="​Download ​MoCA" icon="​fa fa-download" no-body="​true">​ 
-^ Visuospatial/​Executive  ​Clock                          ​• Constructional praxis \\ • Executive function ​                          | • Right parietal lobe \\ • Dorsolateral prefrontal cortex ​                  | +<btn type="​primary"​ block="​true"​ icon="​fa fa-file">​{{::​moca_instructions.pdf|Instructions}}<​/btn> ​          
-^ Naming ​                 | Animals ​                       | • Semantic knowledge \\ • Vocalization and articulation ​                  | • Anterior temporal lobes (bilateral) \\ • Broca’s area and insular cortex ​ | +<btn type="​success"​ block="​true"​ icon="​fa fa-download">​{{:​moca-test-english_7_1.pdf|MoCA (v7.1)}}</btn> ​    |
-^ 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 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 ​                                                                |+
 </​panel>​ </​panel>​
 +<panel type="​info"​ title="​Download Alternate Versions"​ icon="​fa fa-download"​ no-body="​true">​
 +| <btn type="​success"​ block="​true"​ icon="​fa fa-download">​{{:​moca-test-english_7.2.pdf |v7.2 (Bear)}}</​btn> ​                     |
 +| <btn type="​success"​ block="​true"​ icon="​fa fa-download">​{{ :​moca-test-english_7_3_june_13.pdf |v7.3 (Pig)}}</​btn> ​             |
 +| <btn type="​success"​ block="​true"​ icon="​fa fa-download">​{{ :​moca-8.1-english-test-2018-03.pdf |v8.1 (Rhino)}}</​btn> ​           |
 +| <btn type="​danger"​ block="​true"​ icon="​fa fa-download">​{{ :​moca-version-8.2-english-test-2018-02.pdf |v8.2 (Elephant)}}</​btn> ​ |
 +| <btn type="​success"​ block="​true"​ icon="​fa fa-download">​{{ :​moca-8.3-english-test-2018-04.pdf |v8.3 (Tiger)}}</​btn> ​           |
 +</​panel>​
 +</​WRAP>​
 +</​WRAP>​
  
-<callout type="tip" ​title="Scoring Tips" icon="​true"> +==== Indications ==== 
-  ​* **F-word fluency**: Proper names (e.g. - FrankFredetc.are not allowedWords generated ​from a single stem are also not allowed ​(e.g. - pot, potspotter, potted) +<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" ​type="success">See also articles: ​**[[geri:​dementia:​home|]]** and **[[cognitive-testing:​introduction|]]**</​alert>​ 
-  * **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.+The MoCA is best used for screening for [[cl:3-mild-neurocog-disorder|mild neurocognitive disorder]] ​(i.e. - mild cognitive impairment). Cognitive tests are **not** diagnosticand require interpretation by a clinician in conjunction with other factorsincluding a patient'​s clinical history, risk factors, and investigations. 
 + 
 +===== Components and Scoring ===== 
 +All instructions in the MoCA may be repeated only once. The instructions and scoring below are described for MoCA version 7.1. 
 +==== Alternating Trail Making ==== 
 +<WRAP group> 
 +<WRAP half column>​ 
 +Instruct the patient: "//​Please draw a line going from a number to a letter in ascending order. Begin here [point to (1)] and draw a line from 1 then to A then to 2 and so onEnd here [point to (E)]//.
 +</​WRAP>​ 
 +<WRAP half column>​ 
 +<callout title="​Scoring">​ 
 +  * ''​1''​ point is given if the patient successfully draws the following pattern: 1->​A->​2->​B->​3->​C->​4->​D->​5->​Ewithout drawing any lines that cross 
 +  * Any error that is not immediately self-corrected (meaning corrected before moving on to the Cube task) earns a score of 0.  
 +  ​A point is also not given if the patient ​draws a line to connect ​the end (E) to the beginning (1)
 </​callout>​ </​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Visuoconstructional Skills (Drawing) ====
 +<WRAP group>
 +<WRAP half column>
 +Point to the drawing, instructing:​ “//Copy this drawing as accurately as you can//.”
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +''​1''​ point is allocated for a correctly executed drawing. A point is not assigned if any of the below criteria are not met:
 +  * Drawing must be three-dimensional
 +  * All lines are drawn
 +  * All lines meet with little or no space
 +  * No line is added
 +  * Lines are relatively parallel and their length is similar (rectangular prisms are accepted)
 +  * For the cube drawing, the cube’s orientation in space must be preserved
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Visuoconstructional Skills (Clock) ====
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main article: **[[cognitive-testing:​clock-drawing-test|]]**</​alert>​
 +<WRAP group>
 +<WRAP half column>
 +Ensure that the subject does not look at his/her watch while performing the task and that no clocks are in sight. The examiner indicates the appropriate space and gives the following instructions:​ "//​Draw a clock. Put in all the numbers and set the time to 10 past 11//."
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +''​1''​ point is allocated for each of the following ''​3''​ criteria:
 +  * **Contour** (1 point): the clock contour must be drawn (either a circle or a square). Only minor distortions are acceptable (e.g. - slight imperfection on closing the circle). If the numbers are arranged in a circular manner but the contour is not drawn the contour is scored as incorrect
 +  * **Numbers** (1 point): all clock numbers must be present with no additional numbers. Numbers must be in the correct order, upright and placed in the approximate quadrants on the clock face. Roman numerals are acceptable. The numbers must be arranged in a circular manner (even if the contour is a square). All numbers must either be placed inside or outside the clock contour. If the subject places some numbers inside the clock contour and some outside the clock contour, (s)he does not receive a point for Numbers.
 +  * **Hands** (1 point): there must be two hands jointly indicating the correct time. The hour hand must be clearly shorter than the minute hand. Hands must be centered within the clock face with their junction close to the clock center.
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Naming ====
 +<WRAP group>
 +<WRAP half column>
 +Instruct the patient by beginning on the left, and point to each figure and say: "//​Tell me the name of this animal//"​.
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +''​1''​ point each is given for the following responses (for version 7.1):
 +  - Camel or dromedary
 +  - Lion
 +  - Rhinoceros or rhino 
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Memory ====
 +<WRAP group>
 +<WRAP half column>
 +Read a list of 5 words at a rate of 1 word per second, giving the following instructions:​ "//​This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn’t matter in what order you say them//​."​ Mark a check in the allocated space for each word the subject produces on this first trial. ​
 +
 +When the subject indicates that (s)he has finished (has recalled all words), or can recall no more words, read the list a second time with the following instructions:​ "//I am going to read the same list for a second time. Try to remember and tell me as many words as you can, including words you said the first time//​."​ Put a check in the allocated space for each word the subject recalls after the second trial. At the end of the second trial, inform the subject that (s)he will be asked to recall these words again by saying, "//I will ask you to recall those words again at the end of the test//​." ​
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +  * There is no scoring in this section.
 +  * The examiner cannot correct the subject if the subject recalls a word incorrectly,​ or if they substitute it for a similarly sounding word!
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Attention (Digit Span) ====
 +<WRAP group>
 +<WRAP half column>
 +  * **Forward Digit Span:** Give the following instructions:​ “//I am going to say some numbers and when I am through, repeat them to me exactly as I said them//​."​ Read the five number sequence at a rate of one digit per second.
 +  * **Backward Digit Span**: Give the following instructions:​ "//Now I am going to say some more numbers, but when I am through you must repeat them to me in the backwards order.//"​ Read the three number sequence at a rate of one digit per second.
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +  * Allocate ''​1''​ point for each sequence correctly repeated.
 +  * The examiner cannot correct or remind the subject if the subject repeats the ‘backwards’ series of numbers in ‘forwards’ order!
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Attention (Vigilance) ====
 +<WRAP group>
 +<WRAP half column>
 +Read the list of letters at a rate of one per second, after giving the following instructions:​ “//I am going to read a sequence of letters. Every time I say the letter A, tap your hand once. If I say a different letter, do not tap your hand//​."​
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +Give ''​1''​ point if there is zero to one errors (an error is a tap on a wrong letter or a failure to tap on letter A)
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Attention (Serial 7s) ====
 +<WRAP group>
 +<WRAP half column>
 +Give the following instructions:​ "//​Now,​ I will ask you to count by subtracting seven from 100, and then, keep subtracting seven from your answer until I tell you to stop//​."​ Give this instruction twice if necessary.
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +This item is scored out of ''​3''​ points. Give no (''​0''​) points for no correct subtractions,​ ''​1''​ point for one correction subtraction,​ ''​2''​ points for two-to-three correct subtractions,​ and ''​3''​ points if the participant successfully makes four or five correct subtractions. Count each correct subtraction of 7 beginning at 100. Each subtraction is evaluated independently;​ that is, if the participant responds with an incorrect number but continues to correctly subtract 7 from it, give a point for each correct subtraction. For example, a participant may respond “92 –> 85 –> 78 –> 71 –> 64” where the “92” is incorrect, but all subsequent numbers are subtracted correctly. This is only considered one error and the item would be given a score of 3.
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Sentence Repetition ====
 +<WRAP group>
 +<WRAP half column>
 +Give the following instructions:​ "//I am going to read you a sentence. Repeat it after me, exactly as I say it// [pause]: //I only know that John is the one to help today//.” Following the response, say: “//Now I am going to read you another sentence. Repeat it after me, exactly as I say it// [pause]: //The cat always hid under the couch when dogs were in the room.//"​
 +
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +Allocate ''​1''​ point for each sentence correctly repeated. Repetition must be **exact**. Be alert for errors that are omissions (e.g. - omitting "​only",​ "​always"​) and substitutions/​additions (e.g. - "John is the one who helped today;"​ substituting "​hides"​ for "​hid",​ altering plurals, etc.).
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Verbal Fluency ====
 +<WRAP group>
 +<WRAP half column>
 +Give the following instructions:​ “//Tell me as many words as you can think of that begin with a certain letter of the alphabet that I will tell you in a moment. You can say any kind of word you want, except for proper nouns (like Bob or Boston), numbers, or words that begin with the same sound but have a different suffix, for example, love, lover, loving. I will tell you to stop after one minute. Are you ready? [Pause] Now, tell me as many words as you can think of that begin with the letter F.// [time for 60 sec]. //​Stop//​.”
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +Allocate ''​1''​ point if the subject generates 11 words or more in 60 seconds. Record the subject’s response in the bottom or side margins. ​
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Abstraction ====
 +<WRAP group>
 +<WRAP half column>
 +Ask the patient to explain what each pair of words has in common, starting with the example: “//Tell me how an orange and a banana are alike//”. If the subject answers in a concrete manner, then say only one additional time: “//Tell me another way in which those items are alike//”. If the subject does not give the appropriate response (fruit), say, “//Yes, and they are also both fruit//.” Do not give any additional instructions or clarification. After the practice trial, say: “//Now, tell me how a train and a bicycle are alike//”. Following the response, administer the second trial, saying: “//Now tell me how a ruler and a watch are alike//”. Do not give any additional instructions or prompts. ​
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +Only the last two item pairs are scored. Give ''​1''​ point to each item pair correctly answered. The following responses are acceptable:
 +  * Train-bicycle = means of transportation / means of travelling / you take trips in both ( = they have wheels, is not acceptable)
 +  * Ruler-watch = measuring instruments / used to measure ( = they have numbers, is not acceptable)
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Delayed Recall ====
 +<WRAP group>
 +<WRAP half column>
 +Give the following instructions:​ “//I read some words to you earlier, which I asked you to remember. Tell me as many of those words as you can remember//​."​ Make a check mark for each of the words correctly recalled spontaneously without any cues, in the allocated space.
 +
 +<callout type="​info"​ title="​Optional Step" icon="​true">​
 +Following the delayed free recall trial, prompt the subject with the semantic category cue provided below for any word not recalled. Make a check mark in the allocated space if the subject remembered the word with the help of a category or multiple-choice cue. Prompt all non-recalled words in this manner. If the subject does not recall the word after the category cue, give him/her a multiple choice trial, using the following example instruction,​ “//Which of the following words do you think it was, NOSE, FACE, or HAND?//” Use the following category and/or multiple-choice cues for each word, when appropriate:​
 +  * **FACE**: category cue: part of the body multiple choice: nose, face, hand
 +  * **VELVET**: category cue: type of fabric multiple choice: denim, cotton, velvet
 +  * **CHURCH**: category cue: type of building multiple choice: church, school, hospital
 +  * **DAISY**: category cue: type of flower multiple choice: rose, daisy, tulip
 +  * **RED**: category cue: a colour multiple choice: red, blue, green
 +</​callout>​
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +  * Allocate ''​1''​ point for each word recalled freely without any cues. 
 +  * No points are allocated for words recalled with a cue. A cue is used for clinical information purposes only and can give the test interpreter additional information about the type of memory disorder. For memory deficits due to retrieval failures, performance can be improved with a cue. For memory deficits due to encoding failures, performance does not improve with a cue.
 +</​callout>​
 +
 +<callout type="​tip"​ title="​Clinical Correlation Required"​ icon="​true">​
 +If the patient can recall words with multiple choice or category cues, then it suggests the words were encoded in the hippocampus,​ but unable to be retrieved. This would suggest a frontal lobe deficit, more commonly seen in [[geri:​dementia:​vascular|vascular dementia]], [[geri:​dementia:​frontotemporal|frontotemporal dementia]], or [[geri:​dementia:​parkinsons|Parkinson’s dementia]].[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC5467712/​|Ritter,​ A., Hawley, N., Banks, S. J., & Miller, J. B. (2017). The association between montreal cognitive assessment memory scores and hippocampal volume in a neurodegenerative disease sample. Journal of Alzheimer'​s Disease, 58(3), 695-699.]])][([[https://​pubmed.ncbi.nlm.nih.gov/​27672033/​|Cerciello,​ M., Isella, V., Proserpi, A., & Papagno, C. (2017). Assessment of free and cued recall in Alzheimer’s disease and vascular and frontotemporal dementia with 24-item Grober and Buschke test. Neurological Sciences, 38(1), 115-122.]])]
 +</​callout>​
 +
 +</​WRAP>​
 +</​WRAP>​
 +
 +
 +==== Orientation ====
 +Allocate ''​1''​ point for each word recalled freely without any cues. 
 +
 +<WRAP group>
 +<WRAP half column>
 +  * Give the following instructions:​ "//​Tell me the date today//"​. If the subject does not give a complete answer, then prompt accordingly by saying: "//​Tell me the [year, month, exact date, and day of the week]//​."​ Then say: "//​Now,​ tell me the name of this place, and which city it is in//."
 +</​WRAP>​
 +<WRAP half column>
 +<callout title="​Scoring">​
 +  * Give ''​1''​ point for each item correctly answered. The patient must tell the exact date and the exact place (name of hospital, clinic, office). No points are allocated if the patient makes an error of one day for the day and date.
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== Total Score ====
 +Sum all subscores listed on the right-hand side. Add ''​1''​ point for an individual who has 12 years or fewer of formal education, for a possible maximum of 30 points. A final total score of ''​26''​ and above is considered normal.
 +
 +===== Neuroanatomical Correlates =====
 +<panel title="​MoCA Cognitive Domains and Neuroanatomy"​ no-body="​true">​
 +<​mobiletable 1>
 +^ Category ​               ^ Test                                                    ^ Cognitive domain ​                                                               ^ Neuroanatomical region ​                                                                                                                                                                                                                                                                                                                                                                                                              ^
 +^ Visuospatial/​Executive ​ | Trails ​                                                 | Executive function ​                                                             | • Dorsolateral prefrontal cortex (DLFPC)\\ • Trail making requires cognitive flexibility generated through the dorsolateral and medial prefrontal cortices.[([[https://​pubmed.ncbi.nlm.nih.gov/​12563376/​|Moll,​ J., Oliveira-Souza,​ R. D., Moll, F. T., Bramati, I. E., & Andreiuolo, P. A. (2002). The cerebral correlates of set-shifting:​ an fMRI study of the trail making test. Arquivos de Neuro-psiquiatria,​ 60, 900-905.]])] ​ |
 +^ Visuospatial/​Executive ​ | Cube                                                    | • Executive function \\ • Visual/​spatial perception, construction praxis ​       | • Dorsolateral prefrontal cortex \\ • Right parietal lobe                                                                                                                                                                                                                                                                                                                                                                            |
 +^ Visuospatial/​Executive ​ | [[cognitive-testing:​clock-drawing-test|Clock drawing]] ​ | • 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\\ • [[neurology:​approach-aphasia|Aphasia]] ​ | Dorsolateral prefrontal cortex ​                                                                                                                                                                                                                                                                                                                                                                                                      |
 +^ Language ​               | Fluency (F-words in 1 minute) ​                          | • Working memory/​executive function \\ • Phonemic fluency ​                      | Dorsolateral prefrontal cortex ​                                                                                                                                                                                                                                                                                                                                                                                                      |
 +^ Abstraction ​            | Similarities ​                                           | Conceptualization,​ abstract thinking, higher level thinking ​                    | Dorsolateral prefrontal cortex ​                                                                                                                                                                                                                                                                                                                                                                                                      |
 +^ Delayed Recall ​         | 5 word delayed recall ​                                  | Memory ​                                                                         | Hippocampus ​                                                                                                                                                                                                                                                                                                                                                                                                                         |
 +^ Orientation ​            | Date, time, place                                       | Memory ​                                                                         | Hippocampus ​                                                                                                                                                                                                                                                                                                                                                                                                                         |
 +</​mobiletable></​panel>​
 +
 ===== Norms ===== ===== Norms =====
 Suggested cut-off scores by the creator of the MoCA, are as follows:​[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​15817019|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.]])] Suggested cut-off scores by the creator of the MoCA, are as follows:​[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​15817019|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.]])]
  
 <panel type="​info"​ title="​MoCA Cut-off Scores"​ no-body="​true"​ subtitle="​Nasreddine,​ Ziad S., et al. MoCA: a brief screening tool for mild cognitive impairment. J Am Geri 53.4 (2005): 695-699.">​ <panel type="​info"​ title="​MoCA Cut-off Scores"​ no-body="​true"​ subtitle="​Nasreddine,​ Ziad S., et al. MoCA: a brief screening tool for mild cognitive impairment. J Am Geri 53.4 (2005): 695-699.">​
 +<​mobiletable 1>
 ^                          ^ Normal Controls ​ ^ Mild Cognitive Impairment ​ ^ Alzheimer'​s Disease ​ ^ ^                          ^ Normal Controls ​ ^ Mild Cognitive Impairment ​ ^ Alzheimer'​s Disease ​ ^
 | N                        | 90               | 94                         | 93                   | | N                        | 90               | 94                         | 93                   |
Line 57: Line 275:
 | Range                    | 25.2             | 19.0-25.2 ​                 | 11.4-21.0 ​           | | Range                    | 25.2             | 19.0-25.2 ​                 | 11.4-21.0 ​           |
 | Suggested cut-off score  | ≥ 26             | < 26                       | < 26                 | | Suggested cut-off score  | ≥ 26             | < 26                       | < 26                 |
 +</​mobiletable>​
 </​panel>​ </​panel>​
 ==== Other ==== ==== Other ====
 <panel type="​info"​ title="​Other Data Sets" no-body="​true"​ subtitle="">​ <panel type="​info"​ title="​Other Data Sets" no-body="​true"​ subtitle="">​
-| 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.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​23662720|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.]])] ​ | <button ​type="​success"​ icon="​fa fa-download">​[[http://​psychdb.com/​_media/​cognitive-testing/​tildanorms.pdf|Download ​TILDA Norms (PDF)]]</button>  |+| 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.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​23662720|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.]])] ​ | <btn type="​success"​ icon="​fa fa-download">​[[http://​psychdb.com/​_media/​cognitive-testing/​tildanorms.pdf|Download]]</​btn>  |
 </​panel>​ </​panel>​
 +
 +===== MoCA Basic =====
 +The **Montreal Cognitive Assessment – Basic (MoCA-B)** is used for screening of mild cognitive impairment in illiterate and low education individuals. The MoCA-B cognitive domains similar to the original MoCA (executive functions, language, orientation,​ calculations,​ conceptual thinking, memory, visuoperception,​ attention and concentration).
 +===== MoCA Virtual =====
 +==== MoCA Telephone/​Blind ====
 +<WRAP group>
 +<WRAP twothirds column>
 +The MoCA can also be performed remotely over the telephone or via a videoconferencing.[([[https://​pubmed.ncbi.nlm.nih.gov/​23138443/​|Pendlebury,​ S. T., Welch, S. J., Cuthbertson,​ F. C., Mariz, J., Mehta, Z., & Rothwell, P. M. (2013). Telephone assessment of cognition after transient ischemic attack and stroke: modified telephone interview of cognitive status and telephone Montreal Cognitive Assessment versus face-to-face Montreal Cognitive Assessment and neuropsychological battery. Stroke, 44(1), 227-229.]])] The MoCA version with no visual elements (i.e. - MoCA Blind version) is scored out of 22, with a cut-off score ≥ 19.
 +</​WRAP>​
 +<WRAP third column>
 +<panel type="​info"​ title="​Download MoCA" icon="​fa fa-download"​ no-body="​true">​
 +| <btn type="​success"​ block="​true"​ icon="​fa fa-download">​{{ :​cognitive-testing:​moca_test_blind_version_7.1.pdf |MoCA Blind Version (v7.1)}}</​btn>​ |
 +</​panel>​
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== MoCA Video ====
 +The MoCA can also be done via video assessment.[([[https://​pubmed.ncbi.nlm.nih.gov/​31746697/​|Iiboshi,​ K., Yoshida, K., Yamaoka, Y., Eguchi, Y., Sato, D., Kishimoto, M., ... & Kishimoto, T. (2019). A Validation Study of the Remotely Administered Montreal Cognitive Assessment Tool in the Elderly Japanese Population. Telemedicine and e-Health.]])] The principles of cognitive testing with the MoCA remains the same with some minor changes:
 +  * **Trails**: Show the trail and say: "​Please tell me where the arrow should go next to follow the pattern I am showing you"
 +  * **Cube**: Show the cube and say: "Copy the cube"
 +  * **Date**: "Look directly at the camera and tell me today'​s date, day of the week, month and year"
 +  * **Place**: "What hospital/​clinic/​institution am I calling you from?"
 +  * **City**: "What is the city in which our hospital/​clinic/​institution is located?"​
  
 ===== Resources ===== ===== Resources =====
   * {{ :​cognitive-testing:​moca_localization.pdf |MoCA Neuroanatomical Correlations}}   * {{ :​cognitive-testing:​moca_localization.pdf |MoCA Neuroanatomical Correlations}}
  
-{{tag>moca}}+{{tag>cognitive-testing-common}}