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

What is the Montreal Cognitive Assessment?

The Montreal Cognitive Assessment (MoCA) is a 30-question test that screens adults age 55-85 for mild cognitive impairment and early signs of dementia. Created in 2005 at McGill University, the test is intended to be administered and graded by a medical professional, who will then decide if more tests are necessary. The test is able to detect many types of dementia, although it can not be used to differentiate between dementia types. The MoCA should not be used on its own for diagnosis, but it can accurately detect early signs of dementia 90% of the time.

How Does it Work?

The MoCA evaluates seven areas of brain function with 30 tasks, exercises and questions. In general, the MoCA covers:

• 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

Pros and Cons

Pros:

• Highly accurate – Studies have shown MoCA to correctly identify dementia at a 90% rate, and it identifies those who do not have dementia at an 87% rate.
• Simple and brief – The MoCA takes only 10-15 minutes to complete.
• Detects early – Other cognitive tests are less effective than the MoCA at detecting the early stage of dementia or mild cognitive impairment.
• Detects Parkinson’s dementia – The MoCA can identify dementia caused by Parkinson’s disease, which can have symptoms unlike other dementias and is not detected by all cognitive tests.

Cons

• Doctor required – The MoCA must be administered and graded by a healthcare professional, so an appointment with a nurse, doctor, or therapist is needed.
• No diagnosis – The MoCA must be paired with other tests including brain scans and a neurological testing before a diagnosis can be made.

Accuracy

When discussing a test like the MoCA, researchers refer to its sensitivity (the ability to identify those who have the disease) and its specificity (the ability to identify those without the disease). A study published by BMC Geriatrics in 2015 showed that the MoCA had a sensitivity of 90% in detecting mild cognitive impairment and an 87% specificity. While these numbers are excellent, they are not perfect – 10% of the time the MoCA returns a false positive of someone having the disease during that 2015 study, and 13% of the time it returned a false positive on someone not having it. This is why the MoCA, like all dementia tests, are used in conjunction with other means of evaluation when diagnosing dementia patients.

Alternatives and Comparisons

There are other tests professionals use in clinical settings to evaluate people showing signs of dementia. The most common is the Mini-Mental State Exam (MMSE), which is used by many doctors and researchers studying dementia. The MMSE is most effective for evaluating the severity of a person’s dementia, which is a weakness of the MoCA. However, the MMSE is much less effective than the MoCA when it comes to detecting early dementia or mild cognitive impairment. The Saint Louis University Mental Status (SLUMS) exam, on the other hand, is another clinical test that, like the MoCA, is effective at identifying early stage dementia and mild cognitive impairment.

There are also dementia tests that people can take at home. These tests should only be used as indicators that further evaluation by a professional is needed. They should not be used to diagnose dementia on their own. These at-home tests include:

• Mini-Cog – This test only takes about five minutes to complete and one minute to score. It does require someone to administer it, but that person doesn’t need any type of specialized training. Learn more about the Mini-Cog.
• SAGE – The Self-Administered Gerocognitive Exam (SAGE) is 30-question test that can be taken at home, but to get a full understanding of the results, they need to be taken to a healthcare professional. The SAGE test is effective at catching early signs of dementia. Learn more about the SAGE test.
• MMSE (home version) – The Mini-Mental State Exam (MMSE) was developed nearly 50 years ago and it can be used in clinical settings, as discussed above, as well as at home. By asking 30 questions, the MMSE evaluates an individual’s short-term memory, attention span, problem solving, motor skills and language comprehension and expression (identifying common objects by name). The MMSE is most effective at determining how far dementia has progressed as opposed to detecting whether or not the person has dementia. Learn more about the MMSE.