The Montreal Cognitive Assessment (MoCA) is a widely used
screening assessment for detecting
cognitive impairment.[1] It was created in 1996 by
Ziad Nasreddine in
Montreal,
Quebec. It was validated in the setting of
mild cognitive impairment (MCI), and has subsequently been adopted in numerous other clinical settings. This test consists of 30 points and takes 10 minutes for the individual to complete. The original English version is performed in seven steps, which may change in some countries dependent on education and culture. The basics of this test include
short-term memory,
executive function, attention, focus, and more.
Format
The MoCA is a one-page 30-point test administered in approximately 10 minutes.[2] The test and administration instructions are available for
clinicians online. The test is available in 46 languages and
dialects (as of 2017).
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 function 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).
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.
Abstract reasoning is assessed using a describe-the-similarity task with 2 points being available.
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).
Because MoCA is English-specific, linguistic and cultural translations are made in order to adapt the test in other countries. Multiple cultural and linguistic variables may affect the norms of the MoCA across different countries and languages, e.g. Swedish.[3] Several cut-off scores have been suggested across different languages to compensate for the
education level of the population, and several modifications were also necessary to accommodate certain linguistic and cultural differences across different languages or countries; however, not all versions have been validated.
Efficacy
MoCA test study
A MoCA test validation study by Nasreddine in 2005 showed that the MoCA was a promising tool for detecting MCI and early
Alzheimer's disease compared with the well-known
Mini-Mental State Examination (MMSE).[1]
According to the validation study, the
sensitivity and specificity of the MoCA for detecting MCI were 90% and 87% respectively, compared with 18% and 100% respectively for the MMSE. Subsequent studies in other settings were less promising, though generally superior to the MMSE.[4][5]
Other studies have tested the MoCA on patients with Alzheimer's disease.[6][7][8]
People with
hearing loss, which commonly occurs alongside
dementia, score worse in the MoCA test, which could lead to a false diagnosis of dementia. Researchers have developed an adapted version of the MoCA test, which is accurate and reliable and avoids the need for people to listen and respond to questions.[9][10]
MoCA scores range between 0 and 30.[12] A score of 26 or over is considered to be normal. In a study, people without cognitive impairment scored an average of 27.4; people with MCI scored an average of 22.1; people with
Alzheimer's disease scored an average of 16.2.[12]
In a study by Ihle-Hansen et al. (2017), of 3,413 Norwegian participants aged 63–65, of whom 47% had higher education (over 12 years), under 5% of subjects scored 30/30 with a mean MoCA score of 25.3 and 49% scoring below the suggested cut-off of 26 points, leading the authors to suggest that "the cut-off score may have been set too high to distinguish normal cognitive function from MCI".[13]
^Dong, YanHong; Sharma, Vijay Kumar; Chan, Bernard Poon-Lap; Venketasubramanian, Narayanaswamy; Teoh, Hock Luen; Seet, Raymond Chee Seong; Tanicala, Sophia; Chan, Yiong Huak; Chen, Christopher (2010-12-15). "The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke". Journal of the Neurological Sciences. 299 (1–2): 15–18.
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^Fujiwara, Yoshinori; Suzuki, Hiroyuki; Yasunaga, Masashi; Sugiyama, Mika; Ijuin, Mutsuo; Sakuma, Naoko; Inagaki, Hiroki; Iwasa, Hajime; Ura, Chiaki (2010-07-01). "Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment". Geriatrics & Gerontology International. 10 (3): 225–232.
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^Luis, Cheryl A.; Keegan, Andrew P.; Mullan, Michael (2009-02-01). "Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US". International Journal of Geriatric Psychiatry. 24 (2): 197–201.
doi:
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^Dalrymple-Alford, J. C.; MacAskill, M. R.; Nakas, C. T.; Livingston, L.; Graham, C.; Crucian, G. P.; Melzer, T. R.; Kirwan, J.; Keenan, R. (2010-11-09). "The MoCA: well-suited screen for cognitive impairment in Parkinson disease". Neurology. 75 (19): 1717–1725.
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^Wong, Adrian; Xiong, Yun Y.; Kwan, Pauline W. L.; Chan, Anne Y. Y.; Lam, Wynnie W. M.; Wang, Ki; Chu, Winnie C. W.; Nyenhuis, David L.; Nasreddine, Ziad (2009-01-01). "The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease". Dementia and Geriatric Cognitive Disorders. 28 (1): 81–87.
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^Videnovic, Aleksandar; Bernard, Bryan; Fan, Wenqing; Jaglin, Jeana;
Leurgans, Sue; Shannon, Kathleen M. (2010-02-15). "The Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in Huntington's disease". Movement Disorders. 25 (3): 401–404.
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^Bertrand, Josie-Anne; Marchand, Daphné Génier; Postuma, Ronald B.; Gagnon, Jean-François (2016-07-28). "Cognitive dysfunction in rapid eye movement sleep behavior disorder". Sleep and Biological Rhythms. 11 (1): 21–26.
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^Olson, Robert Anton; Chhanabhai, Taruna; McKenzie, Michael (2008-11-01). "Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases". Supportive Care in Cancer. 16 (11): 1273–1278.
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