Montreal Cognitive Assessment (MoCA)

Screens for mild cognitive impairment.

To be used as a screening tool for adults with self or family reported concerns of cognitive impairment not explained by an alternative medical or psychiatric condition. This score identifies the mild cognitive impairment that may precede various forms of dementia, but does not diagnose specific dementia subtypes.

Does the patient have more than 12 years of education?

Do not include kindergarten years

Visuospatial/executive

Ask patient to trace the diagram in order

Ask patient to copy cube

Ask patient to draw a clock (ten past eleven)

Naming

Ask patient to name the first animal

Ask patient to name the second animal

Ask patient to name the third animal

Memory

Read "Face", "Velvet", "Church", "Daisy", "Red", and ask patient to repeat (do two trials and a recall later in exam)

Attention

Read list of digits (2, 1, 8, 5, 4) at 1 digit/sec and ask patient to repeat them in the forward order

Read list of digits (7, 4, 2) at 1 digit/sec and ask patient to repeat them in the backward order

Read list of letters and ask patient to tap with their hand at each letter A: FBAC MNAA JKLB AFAK DEAA AJAM OFAAB

Ask patient to do five serial 7 subtractions starting at 100; patient should say 93, 86, 79, 72, 65

Language

Read and ask patient to repeat: "I only know that John is the one to help today"

Read and ask patient to repeat: "The cat always hid under the couch when dogs were in the room"

Ask patient to name maximum number of words in 1 minute that begin with the letter F

Abstraction

Ask patient similarity between train and bicycle (e.g. both are modes of transportation)

Ask patient similarity between watch and ruler (e.g. both are measuring tools)

Delayed recall

Ask patient to recall the words with no cue from the memory test previously conducted ("Face", "Velvet", "Church", "Daisy", "Red")

Orientation

Ask patient the date, month, year, day, place, and city

Result:

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Advice

The MoCA should not replace a detailed history, physical exam, and workup as indicated by history.
The MoCA score does not diagnose a specific clinical condition but it does identify the presence of cognitive impairment. Additional workup to determine the cause of the cognitive impairment is usually warranted.
Clinical reasoning is still required to interpret the cause of the patient’s MCI once identified by an abnormal MoCA Score and to assess for functional impairment.

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