Montreal Cognitive Assessment

Overview

Author(s): Nasreddine, Z.

Year of Publication: 2017 (originally published in 2005)

Publisher: MoCA Test Inc.

Type of Assessments: 

• Standardized Cognitive Screening tool

• Performance-based

• Criterion-referenced

Cost: Free (with training)

How to Access: https://mocacognition.com/paper/ 

Age: Older Adults

Diagnoses: Individuals at risk for MCI (Alzheimer's, stroke, Parkinson's, etc).

Setting: outpatient rehab, inpatient rehab, home health, skilled nursing facilities, assisted living, acute rehab, mental health rehab, memory care

Function(s)/Area(s) Assessed:

• Executive & visuospatial skills

• Language & naming

• Short-term & working memory

• Attention & concentration

• Abstraction

• Orientation to time & place

Administration 

Time: 10 mins

Group/Individual: Individual

Subtests: 6

Instructions: Using the administration & scoring instructions, therapist will read through instructions as they are written

• All instructions can be repeated ONCE

• E.g.: Administration: The examiner instructs the subject: "Please draw a line going from a number to a letter in ascending order. Begin here [point to (1)] and draw a line from 1 then to A then to 2 and so on. End here [point to (E)]."

Materials: evaluation form, timer, pencil

User Qualifications: Must be trained and certified to interpret results (anyone with an understanding of involved concepts can administer)

Scoring Procedures

How to Score: Scoring is out of 30 points total, but each section has different scoring criteria:

• E.g.: Alternating trail making: one point is given if pattern is successfully drawn: 1-A-2-B-3-C-4-D-5-E without drawing lines that cross

  • errors that are not immediately self-corrected before moving on to the next task = score of 0

  • no points will be given if a line is drawn to connect the end (E) to the beginning (1)

Score Indications: 

• Scores 26+ are considered normal

• A cutoff score of 26 or lower indicates a possible cognitive impairment

Psychometrics

Reliability: Good

• Cronbach's alpha = 0.83

Validity: 

• Factorial Validity: Good

• Convergent Validity: Adequate (CCC = 0.84)

• Discriminant Validity: Good

Sensitivity: 90% (for MCI)

Specificity: 87% (for MCI)

Pros & Cons

Strengths:

• Quick, accurate, & simple to administer

• Performance-based to limit self-report bias

• Education levels are adjusted for

• Required training ensures that administrators are well-prepared and limits the risk of errors

• Online & paper versions

• Three validated versions (8.1, 8.2, 8.3) are available to decrease the learning effect

• Utilized internationally by various professionals

• Culturally sensitive: MoCA-Basic is an adapted version to detect MCI in subjects who are illiterate or possess a low education level 

• Offers a modified version (MoCA-B Blind) that adapts the MoCA-Basic to contain the same items except those requiring visual capabilities and will be administered by voice only via telephone

Weaknesses:

• Does not provide a detailed neurophysiological assessment, it is more of a quick overview of cognitive status

• Can be a challenging task for some and may lead to false positives to suggest an impairment when there is not one 

• Requires training/certification which can limit accessibility 

References

• MoCA Cognition. (n.d.). Paper versions. https://mocacognition.com/paper/ 

• MoCA Cognition. (2017). Montreal Cognitive Assessment (MoCA) [Version 8.1]. www.mocacognition.com 

• MoCA Cognition. (2017). Montreal Cognitive Assessment (MoCA) [Version 8.1] Administration and scoring instructions. www.mocacognition.com 

• Nasreddine, Z.S., Phillips, N.A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J.L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of American Geriatrics Society, 53(4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x