Montreal Cognitive Assessment (MoCA) Test: Scoring & Accuracy

Montreal Cognitive Assessment Scoring & Usefulness

Physican Using the MOCA to Screen for Alzheimer's
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What Is the MoCA?

The Montreal Cognitive Assessment (MoCA) is a brief 30-question test that takes around 10-12 minutes to complete. It was published in 2005 by a group at McGill University working for several years at memory clinics in Montreal.

What Does It Evaluate?

The MoCA assesses different types of cognitive abilities, including orientation, short-term memory, executive function, language abilities, attention and visuospatial ability.

Unlike the Mini-Mental State Exam (MMSE), another widely used method of screening for Alzheimer's disease, the MoCA includes a clock-drawing test and a test of the executive function known as Trails B.

Scoring of the MoCA

Scores on the MoCA range from 0 to 30, with a score of 26 and higher generally considered normal. In the initial study data establishing the MoCA, normal controls had an average score of 27.4, compared with 22.1 in people with Mild Cognitive Impairment (MCI), and 16.2 in people with Alzheimer's disease.

Scoring breakdown is as follows:

  • Visuospatial and Executive Functioning: 5 points
  • Animal Naming: 3 points
  • Attention: 6 points
  • Language: 3 points
  • Abstraction: 2 points
  • Delayed Recall (Short-term Memory):5 points
  • Orientation: 6 points
  • Education Level: 1 point is added to the test-taker's score if he has 12 years or less of formal education 

Usefulness of the MoCA

The MoCA is a relatively simple, brief test that helps health professionals determine quickly whether a person has abnormal cognitive function and may need a more thorough diagnostic work-up for Alzheimer's disease.

It may predict dementia in people with Mild Cognitive Impairment (MCI),and because it tests for executive function, it is useful in people with scores of 26 or higher on the MMSE. Finally, it has been shown to identify cognitive problems in people with Parkinson's Disease.

Overall Advantages and Disadvantages of the MoCA

The MoCA's advantages include its brevity, simplicity, and reliability as a screening test for Alzheimer's disease.

In addition, it measures an important component of dementia that's not measured by the MMSE, namely executive function. It seems to work well in Parkinson's disease dementia, and unlike the MMSE it is free for nonprofit use.

Of note, the MoCA is available in more than 35 languages, and there is also a MoCA Test Blind which allows cognitive testing for those who are visually impaired.

A disadvantage of the MoCA is that it takes a little longer than the MMSE to administer, and like many other screenings, it should be paired with multiple other screenings and tests to accurately identify and diagnose dementia.

Sources:

Montreal Cognitive Assessment. http://www.mocatest.org/wp-content/uploads/2015/tests-instructions/MoCA-Test-English_7_1.pdf.

Montreal Cognitive Assessment. 2015. MoCA Test Blind. http://www.mocatest.org/paper-tests/moca-test-blind/

Nasreddine ZS, Phillips NA, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695-699.

Smith T, Gildeh N, et al. The Montreal Cognitive Assessment: validity and utility in a memory clinic setting.Can J Psychiatry. 2007;52:329-332.

Zadikoff C, Fox SH, et al. A comparison of the Mini Mental State Exam to the Montreal Cognitive Assessment in identifying cognitive deficits in Parkinson's disease. Mov Disord. 2008;23:297-299.

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