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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.
 
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.
 
 
Comments/Special Instructions
N/A
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). A normal score is greater than or equal to 26 points. The original suggested cut-off score [MCI or Alzheimer's disease (AD)] was 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. A recent meta-analysis indicated that a score of 23 was more valid, resulting in fewer false positive.
 
Psychometric Properties: There are strong validation studies emerging across patient populations (e.g., cerebrovascular, MCI/AD, Parkinson's disease).
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.
 
Popovic IM, Seric 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.
 
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.
 
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.
 
Stroke:
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.