Montreal Cognitive Assessment (MoCA)

Why Use

More sensitive for MCI than the Mini Mental Status Exam (MMSE) (90% vs 18%), with many patients who have a normal MMSE demonstrating an abnormal score on the MoCA. Early identification of MCI allows for initiation of testing, treatment, and future planning by the patient and their family. For patients exhibiting symptoms of dementia, MMSE may be more appropriate. Quick and easy tool that can be used in the primary care setting in <10 mins to screen for mild cognitive impairment. Reliability has been validated with a high correlation coefficient for test and retest. Validated to screen for MCI which may precede a variety of clinical conditions such as Alzheimer dementia, vascular dementia, and behavioral variant frontotemporal dementia. Can also be useful for identifying cognitive impairment resulting from hypertensive arteriopathy after TIA or minor stroke.

When to Use

Patients with suspect mild cognitive impairment (MCI). This includes patient and family reported gradual memory loss not otherwise explained by an alternative psychiatric, medical, or neurological cause that has been present for ≥6 months.

Formula

Pearls / Pitfalls

Patients with <12 th grade education receive an extra point, to account for education-related bias. Allows for quantifiable monitoring of cognitive decline.

Advice

The MoCA should not replace a detailed history, physical exam, and workup as indicated by history. The MoCA score does not diagnose a specific clinical condition but it does identify the presence of cognitive impairment. Additional workup to determine the cause of the cognitive impairment is usually warranted. Clinical reasoning is still required to interpret the cause of the patient’s MCI once identified by an abnormal MoCA Score and to assess for functional impairment.

More Information

Interpretation: MoCA Score <26 points is 90% sensitive for mild cognitive impairment