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Montreal Cognitive Assessment Test (MoCA) for Dementia & Alzheimer’s

Last Updated: May 29, 2020

 

What is the MoCA?

The Montreal Cognitive Assessment is a 30-question test that tells whether a person shows signs of dementia. It is not meant to make a diagnosis, but studies have shown it is extremely reliable for predicting whether or not someone will be diagnosed with Alzheimer’s disease or another dementia. The test is intended to be administered and graded by a medical professional, who will then decide if more tests are necessary. Again, the MoCA is not a diagnostic tool, but rather an indicator that more tests are required.

  Looking for an at-home dementia test? Several are available for download here.

The 30 questions assess multiple aspects of thinking that are impacted by dementia:
– Orientation: Knowing the day, date, and your present location
– Short-term memory: Ability to hear a word and repeat it back a short time later
– Focus and spatial awareness: Connect numbered dots in sequence, and draw 3-dimensional shapes
– Language: Ability to speak and understand whole sentences, and remember the names of well-known animals or objects
– Concentration: Repeating simple sequences forward and backward
Clock Drawing Test: Famous for evaluating dementia warning signs

The test was created in 2005 by McGill University researchers, working in Montreal with people who have significant memory problems. It is not as basic as the Mini-Cog, which consists of a single memory exercise and the clock drawing test. Another popular test, the Mini-Mental State Exam, is more commonly used by researchers studying dementia, but MoCA is better at identifying mild (early-stage) dementia than the MMSE.

 

Compared to the MMSE

The Mini-Mental State Exam is also a 30-question test for determining if someone shows signs of dementia. The MMSE was invented in the mid-1970s, about 30 years earlier than the MoCA, and is used more often than the MoCA in clinical circles by people studying dementia. While it does a good job testing the same kinds of thinking skills as the MoCA, the MoCA has been demonstrated in studies as better at identifying mild (early-state) dementia than the MMSE.

 

Compared to the SAGE

The Self-Administered Gerocognitive Exam is, as the name suggests, self-administered. This means it can be taken at home without the assistance of a health professional, though it is still advised that the test be graded by a doctor. It is easier than the MoCA, with fewer questions, and takes less time to complete. If you want to decide at home whether it’s a good idea to ask your doctor about signs of dementia, sitting down to take the SAGE test is a good way to start. Get the SAGE here.

 

Compared to the Mini-Cog

The Mini-Cog is a very quick and basic test for signs of dementia, consisting only of a recall test and the Clock Drawing Test. Subjects are told three unrelated words, then asked to draw a clock, then must remember the three words. The Mini-Cog is simple and effective, but not as in-depth. It also doesn’t provide nearly as much information to doctors who are taking the next steps toward making a diagnosis.

  Testing the Caregiver
Some dementia tests are meant to be taken by a caregiver or family member instead of by the individual suspected of having dementia. One of these test, the Modified CDR, is fast, free and available online. Take the Modified CDR Test here.

 

How Accurate is the MoCA?

Studies have found MoCA to be about 94 percent accurate in telling whether a person has dementia or not. This means 94 percent of people who have dementia scored less than 26 out of 30 on MoCA (25 and under is considered at-risk). MoCA is therefore a useful and mostly accurate tool for identifying dementia.

Significantly for people who take the test because they’re worried they may be in the earliest stages of Alzheimer’s disease (or a related dementia), MoCA is much more effective at identifying Mild Cognitive Impairment (MCI) which is often considered the earliest stage of dementia. Some of the questions on the MoCA are intended to test “executive function,” which is the ability to focus and reason through a sequential task. In one section, this means moving from numbers to letters and back and forth in order (1, A, 2, B, etc.). If you’re wondering whether increased forgetfulness is a result of Alzheimer’s or just normal aging, this means MoCA is the best test to take.

Remember, however, that the test is meant to be administered and graded by a doctor. If you want to take a test at home, the SAGE is accurate and designed to be administered by a loved one rather than a medical professional.

 

How to Take the MoCA

MoCA has an official website where it is promoted as a tool for health professionals like doctors to help diagnose their patients who may have dementia. In order to sign up and receive the test, you must be qualified. The test is, therefore, not intended for people to take at home, unless they live with a nurse, therapist, neurologist, or other healthcare professional who has been trained to administer and score the test. The official version of the test, in fact, will not be available after September 2020 to anyone who has not received proper certification, according to the MoCA organization.

Despite this, the actual test can be found online today. A good (unofficial) link is here. Though it is not advisable to administer the test at home, there are instructions right on the test. The problem for anyone who wants to take the MoCA at home without certified supervision is that parts of it must be completed vocally while other sections require a writing utensil. The test-taker would need to write or draw on some sections without seeing others, despite the entire test taking up a single page.

 At-Home Alternatives to the MoCA
Anyone who wants an at-home test should take the SAGE or Mini-Cog, with the help of a friend or loved one. Even the MMSE can be administered at home, though this is not advised. To take the MoCA, call your primary care doctor. A referral to a neurologist or other qualified expert in brain illnesses may be required.

 

Pros and Cons

Pros:
1. Highly accurate. Studies have shown MoCA correctly identifies dementia about 94 percent of the time.

2. Better for early stages. People who are in the early or mild stages of dementia might be able to score high enough on other tests (including the Mini-Mental State Exam) that the score would indicate no dementia is present. MoCA has been proven effective for showing early-stage dementia, or mild cognitive impairment (MCI).

3. Better for Parkinson’s dementia. The MoCA is also better than the MMSE at indicating if people with Parkinson’s disease are showing signs of Parkinson’s disease dementia.

4. Is relatively quick, taking between 10 and 15 minutes to complete.

Cons
1. Must be administered and graded by a healthcare professional, so an appointment with a nurse, doctor, or therapist is required—as opposed to the SAGE and other tests that can be taken at home.

2. Does not provide a diagnosis, so it must be paired with other tests including brain scans and a neurological testing before a diagnosis can be made.