Thirty items assessing multiple cognitive domains are contained in the MoCA: short-term memory (5 points) visuospatial abilities via clock drawing (3 points), and a cube copy task (1 point) executive functioning via an adaptation of Trail Making Test Part B (1 point), phonemic fluency (1 point), and verbal abstraction (2 points) attention, concentration, and working memory via target detection (1 point), serial subtraction (3 points), digits forward (1 point), and digits backward (1 point) language via confrontation naming with low-familiarity animals (3 points), and repetition of complex sentences (2 points) and orientation to time and place (6 points) ( Nasreddine et al., 2005). The Montreal Cognitive Assessment (MoCA Nasreddine et al., 2005) takes approximately 10 minutes to administer and was designed to detect mild cognitive impairment in elders scoring in the normal range on the MMSE. Mast, Adam Gerstenecker, in Handbook of Assessment in Clinical Gerontology (Second Edition), 2010 Montreal Cognitive Assessment (MoCA) See their website for more details.īenjamin T. As of September 2020, completion of a 1-hour online training and certification regarding administration, scoring, and interpretation of the MoCA is required prior to clinicians using it in their clinical practice. The MoCA is free to clinicians ( ) and has been translated into 31 different languages and dialects. They found that 66% of their sample fell below the cut score of 26, indicating “impairment,” and that many of the MoCA items had high failure rates. Rossetti and colleagues (2011) attempted to correct these problems by conducting a normative study of the MoCA in an ethnically diverse sample of healthy participants, as presented in Table 44.5. Additionally, the original cut score of 26 used to identify impairment was developed without fully accounting for other variables that affect test performance (e.g., age, education, sex, and race) and the score has also been shown to identify a high number of false positives in certain populations. First, some studies have demonstrated that its reliability is notably low in nonclinical populations ( Bernstein et al., 2011), which indicates that it should primarily be used only to detect suspected cognitive impairment in clinical patients. Since its inception as a screening measure for MCI, other studies have found the MoCA to outperform the MMSE in screening for general cognitive impairment in Parkinson disease (PD) ( Hoops et al., 2009 Nazem et al., 2009), vascular dementia after acute stroke ( Dong et al., 2010), and Huntington disease (HD) ( Videnovic et al., 2010) as a measure sensitive to early stages of different types of dementia.Īlthough the MoCA has demonstrated its utility as a cognitive screener, there are a few caveats worth noting. More important, the positive predictive value of the MoCA is 89% for both MCI and AD. ![]() The total score ranges from 0 to 30 points, and a cut score of 26 has demonstrated very good specificity (by correctly identifying 87% of healthy participants) and excellent sensitivity when differentiating MCI (90%) and Alzheimer disease (AD) (100%) from healthy comparisons. Including more cognitive domains reduces the likelihood that impairments or disorders will be overlooked (e.g., executive dysfunction, a hallmark symptom of vascular dementia). The MoCA also improved upon the MMSE by probing more cognitive domains, including executive functioning, immediate and delayed memory, visuospatial abilities, attention, working memory, language, and orientation to time and place ( Fig. ![]() The MoCA was originally developed as a screening tool to correct the shortcomings of the widely used MMSE, which demonstrated an insensitivity to mild cognitive impairment ( Nasreddine et al., 2005). Joseph Jankovic MD, in Bradley and Daroff's Neurology in Clinical Practice, 2022 Montreal Cognitive Assessment
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