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| {{Infobox diagnostic | | {{Short description|A cognitive screening test for detecting cognitive impairment}} |
| | name = Montreal Cognitive Assessment | |
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| | purpose =detects cognitive impairment
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| The '''Montreal Cognitive Assessment''' ('''MoCA''') is a widely used screening assessment for detecting cognitive impairment.<ref>{{cite journal |vauthors=Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H |title=The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment |journal=J Am Geriatr Soc |volume=53 |issue=4 |pages=695–9 |year=2005 |pmid=15817019 |doi=10.1111/j.1532-5415.2005.53221.x |url=}}</ref> It was created in 1996 by Ziad Nasreddine in [[Montreal]], [[Quebec]]. It was validated in the setting of mild [[cognitive impairment]], and has subsequently been adopted in numerous other settings clinically.
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| ==Format==
| | The '''Montreal Cognitive Assessment''' (MoCA) is a widely used screening tool for detecting [[cognitive impairment]]. It was designed to assist in the detection of [[mild cognitive impairment]] (MCI) and [[Alzheimer's disease]] in older adults. The MoCA is known for its sensitivity and specificity in identifying cognitive deficits that may not be apparent in routine clinical evaluations. |
| The MoCA test is a one-page 30-point test administered in approximately 10 minutes.<ref>{{Cite book |date=2012-01-01 |title=Psychiatric rating scales |url= |journal=Handbook of Clinical Neurology |volume=106 |pages=227–237 |doi=10.1016/B978-0-444-52002-9.00013-9 |pmid=22608624 |issn=0072-9752|last1=Maust |first1=Donovan |last2=Cristancho |first2=Mario |last3=Gray |first3=Laurie |last4=Rushing |first4=Susan |last5=Tjoa |first5=Chris |last6=Thase |first6=Michael E. |isbn=9780444520029 }}</ref> The test and administration instructions are available for [[clinician]]s online. The test is available in 46 languages and dialects (as of 2017). | |
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| [[File:Superior-pattern-processing-is-the-essence-of-the-evolved-human-brain-fnins-08-00265-g0004.jpg|thumb|300px|In this clock drawing task, the subject is asked to draw a clock with the hours and showing the time 2:30. Successive results show a deterioration of pattern processing ability in a subject as they progress from mild cognitive impairment (MCI) to severe Alzheimer's disease (AD).]]
| | ==History== |
| The MoCA assesses several cognitive domains:
| | The MoCA was developed in 1996 by Dr. Ziad Nasreddine in Montreal, Quebec. It was created to address the limitations of the [[Mini-Mental State Examination]] (MMSE), which was less effective in detecting mild cognitive changes. The MoCA was designed to be a more comprehensive tool, assessing a broader range of cognitive domains. |
| *The short-term [[memory recall]] task (5 points) involves two learning trials of five nouns and delayed recall after approximately five minutes.
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| *[[Visuospatial]] abilities are assessed using a clock-drawing task (3 points) and a three-dimensional cube copy (1 point).
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| *Multiple aspects of executive functions are assessed using an alternation task adapted from the trail-making B task (1 point), a phonemic fluency task (1 point), and a two-item verbal abstraction task (2 points).
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| *Attention, concentration, and working memory are evaluated using a sustained attention task (target detection using tapping; 1 point), a serial subtraction task (3 points), and digits forward and backward (1 point each).
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| *Language is assessed using a three-item confrontation naming task with low-familiarity animals ([[lion]], [[camel]], [[rhinoceros]]; 3 points), repetition of two syntactically complex sentences (2 points), and the aforementioned fluency task.
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| *Finally, orientation to time and place is evaluated by asking the subject for the date and the city in which the test is occurring (6 points).
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| Because MoCA is English specific, linguistic and cultural translations are made in order to adapt the test in other countries. Multiple cultural and linguistic variables may affect the norms of the MoCA across different countries and languages e.g. Swedish.<ref>{{Cite journal|last=Borland|first=Emma|last2=Nägga|first2=Katarina|last3=Nilsson|first3=Peter M.|last4=Minthon|first4=Lennart|last5=Nilsson|first5=Erik D.|last6=Palmqvist|first6=Sebastian|date=2017-07-29|title=The Montreal Cognitive Assessment: Normative Data from a Large Swedish Population-Based Cohort|journal=Journal of Alzheimer's Disease|volume=59|issue=3|pages=893–901|doi=10.3233/JAD-170203|pmc=5545909|pmid=28697562}}</ref> Several cut-off scores have been suggested across different languages to compensate for [[education]] level of the population, and several modifications were also necessary to accommodate certain linguistic and cultural differences across different languages/countries. However, not all versions have been validated.
| | ==Structure== |
| | The MoCA is a one-page, 30-point test administered in approximately 10 minutes. It evaluates several cognitive domains, including: |
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| ==Efficacy==
| | * [[Attention]] and concentration |
| | * [[Executive functions]] |
| | * [[Memory]] |
| | * [[Language]] |
| | * [[Visuoconstructional skills]] |
| | * [[Conceptual thinking]] |
| | * [[Calculations]] |
| | * [[Orientation]] |
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| ===MoCA test study===
| | Each section of the test is designed to assess specific cognitive abilities. For example, the memory section involves learning and recalling a list of words, while the visuoconstructional skills section includes tasks such as drawing a clock. |
| A MoCA test validation study by Nasreddine in 2005 showed that the MoCA was a promising tool for detecting Mild Cognitive Impairment (MCI) and Early [[Alzheimer's disease]] compared with the well-known [[Mini-mental state examination|Mini-Mental State Examination]] (MMSE).<ref>{{Cite journal|last=Nasreddine|first=Ziad S.|last2=Phillips|first2=Natalie A.|last3=Bédirian|first3=Valérie|last4=Charbonneau|first4=Simon|last5=Whitehead|first5=Victor|last6=Collin|first6=Isabelle|last7=Cummings|first7=Jeffrey L.|last8=Chertkow|first8=Howard|date=2005-04-01|title=The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment|journal=Journal of the American Geriatrics Society|volume=53|issue=4|pages=695–699|doi=10.1111/j.1532-5415.2005.53221.x|issn=0002-8614|pmid=15817019}}</ref>
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| According to the validation study, the sensitivity and specificity of the MoCA for detecting MCI were 90% and 87% respectively, compared with 18% and 100% respectively for the MMSE. Subsequent studies in other settings were less promising, though generally superior to the MMSE.{{Citation needed|date=August 2016}}
| | ==Scoring== |
| | The MoCA is scored out of 30 points, with a score of 26 or above generally considered normal. Scores below 26 may indicate cognitive impairment, although further evaluation is necessary to determine the cause. The test is adjusted for education level by adding one point for individuals with 12 years or fewer of formal education. |
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| Other studies have tested the MoCA on patients with Alzheimer's disease.<ref>{{Cite journal|last=Fujiwara|first=Yoshinori|last2=Suzuki|first2=Hiroyuki|last3=Yasunaga|first3=Masashi|last4=Sugiyama|first4=Mika|last5=Ijuin|first5=Mutsuo|last6=Sakuma|first6=Naoko|last7=Inagaki|first7=Hiroki|last8=Iwasa|first8=Hajime|last9=Ura|first9=Chiaki|date=2010-07-01|title=Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment|journal=Geriatrics & Gerontology International|volume=10|issue=3|pages=225–232|doi=10.1111/j.1447-0594.2010.00585.x|issn=1447-0594|pmid=20141536}}</ref><ref>{{Cite journal|last=Guo|first=Qi-Hao|last2=Cao|first2=Xin-Yi|last3=Zhou|first3=Yan|last4=Zhao|first4=Qian-Hua|last5=Ding|first5=Ding|last6=Hong|first6=Zhen|date=2010-02-01|title=Application study of quick cognitive screening test in identifying mild cognitive impairment|journal=Neuroscience Bulletin|volume=26|issue=1|pages=47–54|doi=10.1007/s12264-010-0816-4|issn=1995-8218|pmid=20101272|pmc=5560380}}</ref><ref>{{Cite journal|last=Luis|first=Cheryl A.|last2=Keegan|first2=Andrew P.|last3=Mullan|first3=Michael|date=2009-02-01|title=Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US|journal=International Journal of Geriatric Psychiatry|volume=24|issue=2|pages=197–201|doi=10.1002/gps.2101|issn=1099-1166|pmid=18850670}}</ref>
| | ==Applications== |
| | The MoCA is used in various clinical settings, including [[neurology]], [[geriatrics]], and [[psychiatry]]. It is particularly useful for: |
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| ===Recommendations===
| | * Early detection of [[Alzheimer's disease]] and other forms of dementia |
| The [[National Institutes of Health]] and the [[Canadian Stroke Network]] recommended selected subsets of the MoCA for the detection of vascular cognitive impairment.<ref>{{Cite journal|last=Hachinski|first=Vladimir|last2=Iadecola|first2=Costantino|last3=Petersen|first3=Ron C.|last4=Breteler|first4=Monique M.|last5=Nyenhuis|first5=David L.|last6=Black|first6=Sandra E.|last7=Powers|first7=William J.|last8=DeCarli|first8=Charles|last9=Merino|first9=Jose G.|date=2006-09-01|title=National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards|journal=Stroke: A Journal of Cerebral Circulation|volume=37|issue=9|pages=2220–2241|doi=10.1161/01.STR.0000237236.88823.47|issn=1524-4628|pmid=16917086}}</ref>
| | * Assessing cognitive function in patients with [[Parkinson's disease]] |
| | | * Evaluating cognitive changes in [[stroke]] patients |
| ==Scoring==
| | * Monitoring cognitive function in [[multiple sclerosis]] |
| MoCA scores range between 0 and 30.<ref name="verywell">{{cite web| url=https://www.verywell.com/alzheimers-and-montreal-cognitive-assessment-moca-98617 | title=Montreal Cognitive Assessment (MoCA) Test: Scoring & Accuracy | work=Verywell | accessdate=12 June 2017 }}</ref> A score of 26 or over is considered to be normal. In a study, people without cognitive impairment scored an average of 27.4; people with [[mild cognitive impairment]] (MCI) scored an average of 22.1; people with [[Alzheimer's disease]] scored an average of 16.2.<ref name="verywell" />
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| ==Other applications== | | ==Advantages== |
| Since the MoCA assesses multiple cognitive domains, it may be a useful cognitive screening tool for several [[Neurological disorder|neurological diseases]] that affect younger populations, such as [[Parkinson's disease]],<ref>{{Cite journal|last=Dalrymple-Alford|first=J. C.|last2=MacAskill|first2=M. R.|last3=Nakas|first3=C. T.|last4=Livingston|first4=L.|last5=Graham|first5=C.|last6=Crucian|first6=G. P.|last7=Melzer|first7=T. R.|last8=Kirwan|first8=J.|last9=Keenan|first9=R.|date=2010-11-09|title=The MoCA: well-suited screen for cognitive impairment in Parkinson disease|journal=Neurology|volume=75|issue=19|pages=1717–1725|doi=10.1212/WNL.0b013e3181fc29c9|issn=1526-632X|pmid=21060094}}</ref><ref>{{Cite journal|last=Kasten|first=Meike|last2=Bruggemann|first2=Norbert|last3=Schmidt|first3=Alexander|last4=Klein|first4=Christine|date=2010-08-03|title=Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease|journal=Neurology|language=en|volume=75|issue=5|pages=478–479|doi=10.1212/WNL.0b013e3181e7948a|issn=0028-3878|pmid=20679642|pmc=2788810}}</ref><ref>{{Cite journal|last=Hoops|first=S|last2=Nazem|first2=S|last3=Siderowf|first3=A D.|last4=Duda|first4=J E.|last5=Xie|first5=S X.|last6=Stern|first6=M B.|last7=Weintraub|first7=D|date=2009-11-24|title=Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease|journal=Neurology|volume=73|issue=21|pages=1738–1745|doi=10.1212/WNL.0b013e3181c34b47|issn=0028-3878|pmc=2788810|pmid=19933974}}</ref> [[vascular cognitive impairment]],<ref>{{Cite journal|last=Cameron|first=Jan|last2=Worrall-Carter|first2=Linda|last3=Page|first3=Karen|last4=Riegel|first4=Barbara|last5=Lo|first5=Sing Kai|last6=Stewart|first6=Simon|date=2010-05-01|title=Does cognitive impairment predict poor self-care in patients with heart failure?|journal=European Journal of Heart Failure|volume=12|issue=5|pages=508–515|doi=10.1093/eurjhf/hfq042|issn=1879-0844|pmid=20354031}}</ref><ref>{{Cite journal|last=Wong|first=Adrian|last2=Xiong|first2=Yun Y.|last3=Kwan|first3=Pauline W. L.|last4=Chan|first4=Anne Y. Y.|last5=Lam|first5=Wynnie W. M.|last6=Wang|first6=Ki|last7=Chu|first7=Winnie C. W.|last8=Nyenhuis|first8=David L.|last9=Nasreddine|first9=Ziad|date=2009-01-01|title=The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease|journal=Dementia and Geriatric Cognitive Disorders|volume=28|issue=1|pages=81–87|doi=10.1159/000232589|issn=1421-9824|pmid=19672065}}</ref> [[Huntington's disease]],<ref>{{Cite journal|last=Videnovic|first=Aleksandar|last2=Bernard|first2=Bryan|last3=Fan|first3=Wenqing|last4=Jaglin|first4=Jeana|last5=Leurgans|first5=Sue|author5-link=Sue Leurgans|last6=Shannon|first6=Kathleen M.|date=2010-02-15|title=The Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in Huntington's disease|journal=Movement Disorders|volume=25|issue=3|pages=401–404|doi=10.1002/mds.22748|issn=1531-8257|pmid=20108371}}</ref> [[brain metastasis]], sleep behaviour disorder,<ref>{{Cite journal|last=Bertrand|first=Josie-Anne|last2=Marchand|first2=Daphné Génier|last3=Postuma|first3=Ronald B.|last4=Gagnon|first4=Jean-François|date=2016-07-28|title=Cognitive dysfunction in rapid eye movement sleep behavior disorder|journal=Sleep and Biological Rhythms|language=en|volume=11|issue=1|pages=21–26|doi=10.1111/j.1479-8425.2012.00547.x|issn=1446-9235}}</ref> primary [[brain tumor]]s (including high and low grade [[glioma]]s),<ref>{{Cite journal|last=Olson|first=Robert Anton|last2=Chhanabhai|first2=Taruna|last3=McKenzie|first3=Michael|date=2008-11-01|title=Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases|journal=Supportive Care in Cancer|volume=16|issue=11|pages=1273–1278|doi=10.1007/s00520-008-0431-3|issn=0941-4355|pmid=18335256}}</ref> [[multiple sclerosis]] and other conditions such as [[traumatic brain injury]], [[Depression (clinical)|depression]], [[schizophrenia]]<ref>{{Cite journal|last=Fisekovic|first=Saida|last2=Memic|first2=Amra|last3=Pasalic|first3=Alma|date=2012-09-01|title=CORRELATION BETWEEN MOCA AND MMSE FOR THE ASSESSMENT OF COGNITION IN SCHIZOPHRENIA|journal=Acta Informatica Medica|volume=20|issue=3|pages=186–189|doi=10.5455/aim.2012.20.186-189|issn=0353-8109|pmc=3508854|pmid=23322976}}</ref> and [[heart failure]]. The test is also used in hospitals to determine whether patients should be allowed to live alone or with a home aide.
| | The MoCA is favored for its: |
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| ==See also==
| | * High sensitivity and specificity for detecting MCI |
| * [[Mini–Mental State Examination]] (MMSE) | | * Comprehensive assessment of multiple cognitive domains |
| | * Quick administration time |
| | * Availability in multiple languages |
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| ==References== | | ==Limitations== |
| {{Reflist}}
| | While the MoCA is a valuable tool, it has limitations, including: |
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| ==External links==
| | * Potential for false positives in individuals with lower education levels |
| * [http://www.mocatest.org/wp-content/uploads/2017/01/MoCA-New-Test-8.1-2017-04.pdf Montreal Cognitive Assessment (MoCA)] ([[Portable Document Format|PDF]]) Version 8.1 English | | * Cultural and language biases that may affect performance |
| | * Requirement for further diagnostic testing to confirm cognitive impairment |
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| {{Neuropsychology tests}}
| | ==Related pages== |
| | * [[Mini-Mental State Examination]] |
| | * [[Cognitive impairment]] |
| | * [[Alzheimer's disease]] |
| | * [[Mild cognitive impairment]] |
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| [[Category:Psychiatric instruments]]
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| [[Category:Cognitive tests]] | | [[Category:Cognitive tests]] |
| [[Category:Neuropsychological tests]] | | [[Category:Neuropsychological tests]] |
| [[Category:Geriatrics]] | | [[Category:Medical assessment and evaluation tools]] |
| [[Category:1996 introductions]]
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| {{dictionary-stub1}}
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A cognitive screening test for detecting cognitive impairment
The Montreal Cognitive Assessment (MoCA) is a widely used screening tool for detecting cognitive impairment. It was designed to assist in the detection of mild cognitive impairment (MCI) and Alzheimer's disease in older adults. The MoCA is known for its sensitivity and specificity in identifying cognitive deficits that may not be apparent in routine clinical evaluations.
History
The MoCA was developed in 1996 by Dr. Ziad Nasreddine in Montreal, Quebec. It was created to address the limitations of the Mini-Mental State Examination (MMSE), which was less effective in detecting mild cognitive changes. The MoCA was designed to be a more comprehensive tool, assessing a broader range of cognitive domains.
Structure
The MoCA is a one-page, 30-point test administered in approximately 10 minutes. It evaluates several cognitive domains, including:
Each section of the test is designed to assess specific cognitive abilities. For example, the memory section involves learning and recalling a list of words, while the visuoconstructional skills section includes tasks such as drawing a clock.
Scoring
The MoCA is scored out of 30 points, with a score of 26 or above generally considered normal. Scores below 26 may indicate cognitive impairment, although further evaluation is necessary to determine the cause. The test is adjusted for education level by adding one point for individuals with 12 years or fewer of formal education.
Applications
The MoCA is used in various clinical settings, including neurology, geriatrics, and psychiatry. It is particularly useful for:
Advantages
The MoCA is favored for its:
- High sensitivity and specificity for detecting MCI
- Comprehensive assessment of multiple cognitive domains
- Quick administration time
- Availability in multiple languages
Limitations
While the MoCA is a valuable tool, it has limitations, including:
- Potential for false positives in individuals with lower education levels
- Cultural and language biases that may affect performance
- Requirement for further diagnostic testing to confirm cognitive impairment
Related pages
