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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Patent Pending

    Montreal Cognitive Assessment (MoCA)

    Screens for mild cognitive impairment and Alzheimer's disease.
    Favorite
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with suspect mild cognitive impairment (MCI). This includes patient and family reported gradual memory loss not otherwise explained by an alternative psychiatric, medical, or neurological cause that has been present for ≥6 months.

    • Patients with <12th grade education receive an extra point, to account for education-related bias.
    • Allows for quantifiable monitoring of cognitive decline.

    • More sensitive for MCI than the Mini Mental Status Exam (MMSE) (90% vs 18%), with many patients who have a normal MMSE demonstrating an abnormal score on the MoCA.

    • Early identification of MCI allows for initiation of testing, treatment, and future planning by the patient and their family. For patients exhibiting symptoms of dementia, MMSE may be more appropriate.

    • Quick and easy tool that can be used in the primary care setting in <10 mins to screen for mild cognitive impairment.

    • Reliability has been validated with a high correlation coefficient for test and retest.

    • Validated to screen for MCI preceding Alzheimer dementia, vascular dementia, behavioral variant frontotemporal dementia, and hypertensive arteriopathy after TIA or minor stroke.

    No
    +1
    Yes
    0
    Visuospatial/executive


    Completed correctly
    +1
    Did not complete correctly
    0


    Completed correctly
    +1
    Did not complete correctly
    0
    Correctly drew all features (i.e., contour, numbers, and hands)
    +3
    Correctly drew two out of three features (i.e., two out of contour, numbers, and hands)
    +2
    Correctly drew contour only
    +1
    Correctly drew numbers only
    +1
    Correctly drew hands only
    +1
    None of the above
    0
    Naming

    Named lion
    +1
    Did not name lion
    0
    Named rhinoceros
    +1
    Did not name rhinoceros
    0
    Named camel
    +1
    Did not name camel
    0
    Memory
    Completed both trials correctly
    Did not complete both trials correctly
    Attention
    Repeated correctly
    +1
    Did not repeat correctly
    0
    Repeated correctly
    +1
    Did not repeat correctly
    0
    <2 errors
    +1
    ≥2 errors
    0
    4 or 5 correct
    +3
    2 or 3 correct
    +2
    1 correct
    +1
    0 correct
    0
    Language
    Repeated correctly
    +1
    Did not repeat correctly
    0
    Repeated correctly
    +1
    Did not repeat correctly
    0
    Named ≥11 words
    +1
    Named <11 words
    0
    Abstraction
    Answered correctly
    +1
    Did not answer correctly
    0
    Answered correctly
    +1
    Did not answer correctly
    0
    Delayed recall
    Recalled all words
    +5
    Recalled 4 words
    +4
    Recalled 3 words
    +3
    Recalled 2 words
    +2
    Recalled 1 words
    +1
    Did not recall any words
    0
    Orientation
    All correct
    +6
    5 correct
    +5
    4 correct
    +4
    3 correct
    +3
    2 correct
    +2
    1 correct
    +1
    None correct
    0

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Critical Actions

    • The MoCA should not replace a detailed history, physical exam, and workup as indicated by history.

    • 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.

    Content Contributors
    • Emma Oberlander, DO
    About the Creator
    Dr. Ziad S. Nasreddine
    Are you Dr. Ziad S. Nasreddine?
    Content Contributors
    • Emma Oberlander, DO