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NINDS CDE Notice of Copyright
Montreal Cognitive Assessment (MoCA)
Availability
Universities/Foundations/Health Professionals/Hospitals/Clinics/Public Health Institutes:
MoCA may be used, reproduced, and distributed, WITH prior written permission. The test should be made available free of charge.
Commercial Entity/Pharma sponsored research:
MoCA may be used, reproduced, and distributed, WITH prior written permission and Licensing Agreement. The test should be made available free of charge.
For additional information, please visit website: Montreal Cognitive Assessment.
Classification
Supplemental – Highly Recommended: Stroke (based on study type, disease stage and disease type), Epilepsy and Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
 
Supplemental: Huntington’s Disease (HD), Mitochondrial Disease (Mito) and Parkinson’s Disease (PD)
Short Description of Instrument
Purpose: The MoCA screens patients who present with mild cognitive complaints and normal mini-mental state examination (MMSE) scores for mild cognitive impairment (MCI). While the MMSE is a ubiquitous cognitive screening instrument, its relative insensitivity to executive dysfunction and the focal cognitive deficits that can often been seen in stroke render it suboptimal for cerebrovascular populations. In fact, a recent study demonstrated the underestimation of cognitive deficits by the MMSE versus the MoCA in individuals with TIAs and stroke in a large population based study.
 
Overview: The MoCA is a screening test of cognition with favorable psychometric properties. It screens eight domains: Visuospatial/executive, Naming, Memory, Attention, Language, Abstraction, Delayed recall, and Orientation.
Time: The assessment takes approximately 10 minutes.
 
Scoring: The total possible score is 30 points (total for each domain: Visuospatial/executive – 5, Naming – 3, Memory – None, Attention – 6, Language – 3, Abstraction – 2, Delayed recall – 5, Orientation – 6). A normal score is greater than or equal to 26 points. The suggested cut-off score [MCI or Alzheimer's disease (AD)] is any score less than 26. One point is added for an individual who has 12 years or fewer of formal education; however the total possible score remains the same. Note that additional studies of optimizing cut-points in different populations are currently underway.
 
Psychometric Properties: There are strong validation studies emerging across patient populations (e.g., cerebrovascular, MCI/AD, Parkinson’s disease).
 
Other Important Notes: Available in various languages (currently 31 total). Raters using this at admission or discharge should develop a standard methodology and scoring instructions for use in hospital setting.
References
Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.J Am Geriatr Soc. 2005;53:695–699.
 
Luis CA, Keegan AP, Mullan M. Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry. 2009;24(2):197–201.
 
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699.
 
Naugle RI, Kawczak K. Limitations of the Mini-Mental State Examination. Cleve Clin J Med. 1989;56(3):277–281.  
Pendlebury ST, Cuthbertson FC, Welch SJ, Mehta Z, Rothwell PM. Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: a population-based study. Stroke. 2010;41(6):1290–1293.
 
Popović IM, Serić V, Demarin V. Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci. 2007;257(1-2):185–193.  
 
Zadikoff C, Fox SH, Tang-Wai DF, Thomsen T, de Bie RM, Wadia P, Miyasaki J, Duff-Canning S, Lang AE, Marras C. A comparison of the mini mental state exam to the Montreal cognitive assessment in identifying cognitive deficits inParkinson's disease. Mov Disord. 2008;23(2):297–299.
 
SAH:
Schweizer TA, Al-Khindi T, Macdonald RL. Mini-Mental State Examination versus Montreal Cognitive Assessment: rapid assessment tools for cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. J Neurol Sci. 2012;316(1-2):137–140.
 
Wong GK, Lam SW, Wong A, Ngai K, Poon WS, Mok V. Comparison of montreal cognitive assessment and mini-mental state examination in evaluating cognitive domain deficit following aneurysmal subarachnoid haemorrhage. PLoS One. 2013;8(4):e59946.
 
HD:
Mickes L, Jacobson M, Peavy G, Wixted JT, Lessig S, Goldstein JL, Corey-Bloom J. A comparison of two brief screening measures of cognitive impairment in Huntington's disease. Mov Disord. 2010;25(13):2229–2233.  
Videnovic A, Bernard B, Fan W, Jaglin J, Leurgans S, Shannon KM. The Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in Huntington's disease. Mov Disord. 2010;25(3):401–404.
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