Montreal Cognitive Assessment (MoCA)
Original Editor- Arnold Fredrick D'Souza
Introduction[edit | edit source]
The MoCA is popular screening tool used to determine if cognitive impairment is present. It takes approximately ten minutes to complete. It evaluates visuospatial skills, attention, language, abstract reasoning, delayed recall, executive function, and orientation. The MoCA covers more domains than the MMSE and, as a consequence, has greater sensitivity and specificity.
Cognitive assessments are fast, easy-to-use, and accurate ways to help diagnose, evaluate progress, and manage many kinds of cognitive impairments. The MoCA is useful in determining a patient’s level of understanding and ability.
It was developed by Dr. Ziad S. Nasreddine and colleagues for quickly screening individuals for mild cognitive impairment.
Intended Population[edit | edit source]
It can be used on the following populations:
- Older adults
- Alzheimer’s dementia
- Vascular cognitive impairment
- Parkinson’s disease
- Progressive supranuclear palsy
- Multiple system atrophy
- Huntington’s disease
- Brain tumours
- Systemic lupus erythematosus
- Substance use disorders
- Idiopathic rapid eye movement sleep behavior disorder
- Risk of falling
- HIV-associated neurocognitive disorders
- Chronic obstructive pulmonary disease
- Obstructive sleep apnoea
Method of Use[edit | edit source]
It is a clinician-reported measure that takes about 10 minutes to administer. It measures cognition under the following domains: visuospatial skills, executive functions, attention, concentration, calculation, language, abstraction, memory, and orientation.
Visuospatial skills and executive function are assessed using the modified trail-making test, copy of the cube, clock drawing test, and naming.
- Attention is assessed using the digit span (forward and backward).
- Concentration and calculation are assessed using the letter A tapping test, and serial 7 subtractions.
- Language is assessed using sentence repetition and letter F fluency.
- Abstraction is assessed by asking about similarities between objects.
- Memory is assessed by a delayed recall of previous answers.
MoCA is scored out of 30. A cut-off score of 26 signifies mild cognitive impairment.
- For a detailed description of MoCA, kindly refer the official brochure found here (Login required, Registration is free).
- Although MoCA is free-to-use, it has been mandated that clinicians and researchers undergo the MoCA Training and Certification Program offered on the official website.
This video demonstrates the use of MoCA. It has hardcoded closed captions.
Evidence[edit | edit source]
Reliability[edit | edit source]
MoCA has high test-retest reliability (ICC = 0.92, p < 0.001). MoCA has good internal consistency (Cronbach's alpha = 0.82).
Validity[edit | edit source]
For content validation, MoCA was compared with the Mini-Mental Status Examination (MMSE), where correlation was found to be high (r = 0.87, p < 0.001). Sensitivity was excellent (90%) and specificity was good (87%) for mild cognitive impairment.
The convergent validity between MoCA and MMSE was high (r = 0.66, p < 0.001).
Translations[edit | edit source]
It has been translated to over 50 languages which can be found on the official website linked below.
Digital applications[edit | edit source]
At present, the MoCA Duo App is available for use on the Apple App Store and Google Play Store. It is administered in-person. It has been validated and is comparable to the standard MoCA. A self-administered version, the MoCA Solo App, will be released in 2022.
Links[edit | edit source]
For more information on MoCA, click here to visit the official website.
References[edit | edit source]
- Kelso IG, Tadi P. Cognitive Assessment. InStatPearls [Internet] 2020 Nov 20. StatPearls Publishing. Available:https://www.ncbi.nlm.nih.gov/books/NBK556049/ (accessed 31.3.2022)
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- Gagnon J-F, Vendette M, Postuma RB, Desjardins C, Massicotte-Marquez J, Panisset M, et al. Mild cognitive impairment in rapid eye movement sleep behavior disorder and Parkinson’s disease. Ann Neurol. 2009;66:39–47.
- Gagnon J-F, Postuma RB, Joncas S, Desjardins C, Latreille V. The Montreal Cognitive Assessment: a screening tool for mild cognitive impairment in REM sleep behavior disorder. Mov Disord. 2010;25:936–40.
- Liu-Ambrose TY, Ashe MC, Graf P, Beattie BL, Khan KM. Increased risk of falling in older community-dwelling women with mild cognitive impairment. Phys Ther. 2008;88:1482–91.
- Phabphal K, Kanjanasatien J. Montreal Cognitive Assessment in cryptogenic epilepsy patients with normal Mini-Mental State Examination scores. Epileptic Disord. 2011;13:375–81.
- Rosca EC, Albarqouni L, Simu M. Montreal Cognitive Assessment (MoCA) for HIV-Associated Neurocognitive Disorders. Neuropsychol Rev. 2019 Sep;29(3):313-27.
- Crişan AF, Oancea C, Timar B, Fira-Mladinescu O, Crişan A, Tudorache V. Cognitive impairment in chronic obstructive pulmonary disease. PLoS One. 2014;9:e102468.
- Chen R, Xiong KP, Huang JY, Lian YX, Jin F, Li ZH, et al. Neurocognitive impairment in Chinese patients with obstructive sleep apnoea hypopnoea syndrome. Respirology. 2011;16:842–8.
- Berg JL, Durant J, Léger GC, Cummings JL, Nasreddine Z, Miller JB. Comparing the Electronic and Standard Versions of the Montreal Cognitive Assessment in an Outpatient Memory Disorders Clinic: A Validation Study. J Alzheimers Dis. 2018;62(1):93-7.