NINDS CDE Notice of Copyright
Montreal Cognitive Assessment (MoCA)
Montreal Cognitive Assessment (MoCA)
Universities/Foundations/Health Professionals/Hospitals/Clinics/Public Health Institutes:
MoCA may be used, reproduced, and distributed, WITHOUT prior written permission.
Written permission and Licensing Agreement is required if funded by commercial entity or pharma.
Permission may be requested by filling out form at https://www.mocatest.org/permission/.
MoCA may be used, reproduced, and distributed, WITH prior written permission and Licensing Agreement.
NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a cognitive screening measure.
Supplemental - Highly Recommended: Stroke (based on study type, disease stage and disease type), Epilepsy, Huntington's Disease (HD), and Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Supplemental: Mitochondrial Disease (Mito) and Parkinson's Disease (PD)
|Short Description of Instrument||
Purpose: The MoCA was designed to efficiently screen for mild to moderate cognitive impairment, including patients with normal mini-mental state examination (MMSE).
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. Alternate forms are available to mitigate practice effects across serial assessments.
Time: The assessment takes approximately 10 minutes.
Language: The MoCA is available as either a paper or app test. The paper test is available in nearly 100 languages, though not all language versions have undergone rigorous validation.
To access the MoCA:
• Create a MoCA account.
• Download either the paper or app test.
• Take the Training & Certification program*.
*Since September 1st 2019, training and certification has become mandatory to administer and score the MoCA Test for clinical, research and educational use. Only certified users will be able to access the test. (Nasreddine, 2020)
The MoCA can be administered remotely via abbreviated telephone version or full version via audio-visual conference (i.e., Skype, FaceTime or Teleconference) (Pendlebury et al. 2013; Wong et al. 2015, 2018).
NeuroRehab Specific: Normative data is most available for older adults, but the MoCA has been increasingly studied in various neurological conditions, across adulthood.
|Scoring and Psychometric Properties||
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). One point is added for an individual who has 12 years or fewer of formal education; however the total possible score remains the same. The cued recall and memory recognition trials do not contribute to the total score.
The original suggested cut-off score was any score less than 26 for differentiating healthy aging from Mild Cognitive Impairment. A recent meta-analysis indicated that a score of 23 was more valid, resulting in fewer false positives. (Carson et al., 2018). A range of cut-off scores have been proposed for different settings and neurological conditions.
Psychometric Properties: There have been strong validation studies emerging across patient populations (e.g., cerebrovascular, MCI/AD, Parkinson's disease). The remotely administered MoCA versions have also been validated across patient populations.
Strengths: The MoCA is less affected by ceiling effects than the MMSE. The MoCA includes items that are sensitive to executive dysfunction and focal cognitive deficits, and may therefore better detect cognitive impairment in certain neurological conditions compared to the MMSE (e.g., Pendlebury et al. 2012).
Weaknesses: Not all test versions (abbreviated, non-English language forms, alternate forms) have been rigorously validated. Reliable change scores for serial assessment have not been well-established for all test-retest timeframes and neurological conditions. MoCA performance is markedly affected by aphasia, and has limited sensitivity to milder cognitive impairments.
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.
Abdolahi A, Bull MT, Darwin KC, Venkataraman V, Grana MJ, Dorsey ER, Biglan KM. A feasibility study of conducting the Montreal Cognitive Assessment remotely in individuals with movement disorders. Health Informatics J. 2016;22(2):304-311.
Benge JF, Kiselica AM. Rapid communication: Preliminary validation of a telephone adapted Montreal Cognitive Assessment for the identification of mild cognitive impairment in Parkinson's disease. Clin Neuropsychol. 2020 Aug 11:1-15.
Carson N, Leach L, Murphy KJ. A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores. Int J Geriatr Psychiatry. 2018 Feb;33(2):379-388.
Chapman JE, Cadilhac DA, Gardner B, Ponsford J, Bhalla R, Stolwyk RJ. Comparing face-to-face and videoconference completion of the Montreal Cognitive Assessment (MoCA) in community-based survivors of stroke. J Telemed Telecare. 2019 Dec 9:1357633X19890788.
Ciesielska N, Sokolowski R, Mazur E, Podhorecka M, Polak-Szabela A, Kedziora-Kornatowska K. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol. 2016;50(5):1039-1052. English, Polish.
DeYoung N, Shenal BV. The reliability of the Montreal Cognitive Assessment using telehealth in a rural setting with veterans. J Telemed Telecare. 2019;25(4):197-203.
Iiboshi K, Yoshida K, Yamaoka Y, Eguchi Y, Sato D, Kishimoto M, Funaki K, Mimura M, Kishimoto T. A Validation Study of the Remotely Administered Montreal Cognitive Assessment Tool in the Elderly Japanese Population. Telemed J E Health. 2020;26(7):920-928.
Lindauer A, Seelye A, Lyons B, Dodge HH, Mattek N, Mincks K, Kaye J, Erten-Lyons D. Dementia Care Comes Home: Patient and Caregiver Assessment via Telemedicine. Gerontologist. 2017;57(5):e85-e93.
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.
Nasreddine ZS. MoCA Test Mandatory Training and Certification: What Is the Purpose? J Am Geriatr Soc. 2020;68(2):444-445.
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.
Pendlebury ST, Markwick A, de Jager CA, Zamboni G, Wilcock GK, Rothwell PM. Differences in cognitive profile between TIA, stroke and elderly memory research subjects: a comparison of the MMSE and MoCA. Cerebrovasc Dis. 2012;34(1):48-54.
Pendlebury ST, Welch SJ, Cuthbertson FC, Mariz J, Mehta Z, Rothwell PM. Telephone assessment of cognition after transient ischemic attack and stroke: modified telephone interview of cognitive status and telephone Montreal Cognitive Assessment versus face-to-face Montreal Cognitive Assessment and neuropsychological battery. Stroke. 2013;44(1):227-229.
Popovic IM, Seric V, Demarin V. Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci. 2007;257(1-2):185-193.
Wong A, Nyenhuis D, Black SE, Law LS, Lo ES, Kwan PW, Au L, Chan AY, Wong LK, Nasreddine Z, Mok V. Montreal Cognitive Assessment 5-minute protocol is a brief, valid, reliable, and feasible cognitive screen for telephone administration. Stroke. 2015;46(4):1059-64.
Wong A, Yiu S, Nasreddine Z, Leung KT, Lau A, Soo YOY, Wong LK, Mok V. Validity and reliability of two alternate versions of the Montreal Cognitive Assessment (Hong Kong version) for screening of Mild Neurocognitive Disorder. PLoS One. 2018;13(5):e0196344.
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 in Parkinson's disease. Mov Disord. 2008;23(2):297-299.
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.
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.
Cumming TB, Churilov L, Linden T, Bernhardt J. Montreal Cognitive Assessment and Mini-Mental State Examination are both valid cognitive tools in stroke. Acta Neurol Scan. 2013;128(2):122-129.
Dong Y, Sharma VK, Chan BP, Narayanaswamy V, Teoh HL, Seet RCS, Tanicala S, Chan YH, Chen C. The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci. 2011;299(1-2):15-18.
Potocnik J, Ovcar Stante K, Rakusa M. The validity of the Montreal cognitive assessment (MoCA) for the screening of vascular cognitive impairment after ischemic stroke. Acta Neurol Belg. 2020;120(3):681-685.
Document last updated January 2022