Montreal Cognitive Assessment

Aka: Montreal Cognitive Assessment, MOCA Exam, Montreal Cognitive Assessment Functional Test

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II. Indications

  1. Dementia Evaluation
  2. Cognitive Function Assessment
  3. Documentation of subsequent cognitive function decline

III. Background

  1. Ten minute exam testing 8 cognitive domains

IV. Criteria (30 points total)

  1. Visual-Spatial and Executive (5 points)
    1. Copy Cube
    2. Draw a Clock showing 10 past 11
      1. One point each for contour, number and hands (3 points total)
    3. Trails B Test
      1. Connect alternating numbers and letters from 1-A to 5-E
  2. Naming (3 points)
    1. Name a lion, rhino, camel
  3. Memory (5 points for delayed recall)
    1. Read a list of 5 words (Face, velvet, church, daisy, red)
      1. Patient repeats the list back twice (no points for this part)
    2. Delayed recall after 5 minutes (at end of exam, after other questions are performed as below)
      1. see Delayed Recall below
  4. Attention (5 points total for 3 components)
    1. Read a list of digits (one per second) and patient should repeat these back in forward order: 2 1 8 5 4
    2. Read a list of digits (one per second) and patient should repeat these back in backwards order: 7 4 2
    3. Read a list of letters and patient should tap with hand everytime the letter A is said: FBAC MNAA JKLB AFAK DEAA AJAM OFAAB
      1. Assign no points if 2 errors or more
    4. Serial Sevens: 93 86 79 72 65
      1. Patient repeatedly subtracts 7, starting from 100
      2. Assign 3 points for 4-5 correct subtractions, assign 2 points for 2-3 correct and 1 point if 1 correct
  5. Language and Fluency (3 points total)
    1. Repeat "I only know that John is the one to help today"
    2. Repeat "The cat always hid under the couch when dogs were in the room"
    3. Name maximum number of words in one minute that begin with the letter F (assign 1 point if more than 11 words)
  6. Abstraction (2 points)
    1. Example: What is the similarity between a banana and a orange? (they are both fruits)
    2. What is the similarity between a train and a Bicycle?
    3. What is the similarity between a watch and a ruler?
  7. Delayed Recall
    1. Patient repeats the 5 words remembered as above (Face, velvet, church, daisy, red)
      1. Assign one point for each item remembered (up to 5 points total)
  8. Orientation (6 points total)
    1. Date
    2. Month
    3. Year
    4. Day
    5. Place
    6. City

V. Interpretation

  1. Add one point if patient has less than a 12th grade education
  2. Total score of 26 or higher is considered normal

VI. Efficacy

  1. Cognitive Impairment (score <26)
    1. Test Sensitivity: 94%
    2. Test Specificity: 60%
    3. Davis (2021) Cochrane Database Syst Rev (7): CD010775 [PubMed]

VII. Resources

  1. Montreal Cognitive Assessment PDF (VA)
    1. https://www.parkinsons.va.gov/resources/MOCA-Test-English.pdf
  2. MoCA Cognitive Assessment
    1. https://mocacognition.com/

VIII. References

  1. Nasreddine (2005) J Am Geriatr Soc 53(4):695-9 +PMID: 15817019 [PubMed]

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