Montreal Cognitive Assessment (MoCA) Test for Dementia

The Montreal Cognitive Assessment (MoCA) is a test used by healthcare providers to evaluate people with memory loss or other symptoms of cognitive decline. It can help identify those at risk for developing Alzheimer's disease and other forms of dementia. It is also used as a screening tool for conditions like Parkinson's disease, brain tumors, substance abuse, and head trauma.

The MoCA contains 30 questions and takes around 10 to 12 minutes to complete. It is a useful screening test, but it needs to be considered alongside the results of other tests to confirm a diagnosis.

Here's a look at what the MoCA test includes, how it's scored and interpreted, and how it can assist in identifying dementia.

Purpose of the MoCA Test

The MoCA test helps health professionals quickly determine whether someone's thinking ability is impaired. It also helps them decide if an in-depth diagnostic workup for Alzheimer's disease is needed.

It may help predict dementia in people with mild cognitive impairment (MCI).

Finally, it's been shown to better identify cognitive problems in people with Parkinson's disease.

How the MoCA Works

The MoCA checks different types of cognitive or thinking abilities. These include:

• Orientation: The test administrator asks you to state the date, month, year, day, place, and city.  
• Short-term memory/delayed recall: Five words are read. The test-taker is asked to repeat them. After completing other tasks, the person is asked to repeat each of the five words again. If they can't recall them, they're given a cue of the category that the word belongs to.
• Executive function/visuospatial ability: These two abilities are checked through the Trails B Test. It asks you to draw a line to sequence alternating digits and letters (1-A, 2-B, etc.). The test also asks you to draw a cube shape.  
• Language: This task asks you to repeat two sentences correctly. It then asks you to list all the words in the sentences that start with the letter "F."
• Abstraction: You are asked to explain how two items are alike, such as a train and a bicycle. This checks your abstract reasoning, which is often impaired in dementia. The proverb interpretation test is another way to measure these skills.
• Animal naming: Three pictures of animals are shown. The person is asked to name each one. This is mainly used to test verbal fluency.
• Attention: The test-taker is asked to repeat a series of numbers forward and then a different series backward. This task tests the ability to pay attention. 
• Clock-drawing test: You're asked to draw a clock that reads 10 minutes past 11:00. 
  

The MoCA vs. the MMSE

The MoCA is similar to a more commonly used test called the mini-mental state exam (MMSE). Both tests use a 30-point scale and take only a few minutes to complete. 

The MMSE is a little shorter than the MoCA. It takes 7 to 8 minutes to complete, while the McCA takes 10 to 12 minutes. The MoCA includes some tasks that the MMSE does not, such as the clock exercise.

Because it tests for executive function, the MoCA is more sensitive in this regard than the (MMSE). This means the MoCA is better at detecting mild disease than the MMSE.

For this reason, the MoCA may be a better choice for people with mild symptoms, while the MMSE is a good option for people with more pronounced symptoms.

Scoring the MoCA Test

Scores on the MoCA range from zero to 30. A score of 26 and higher is considered normal.

The scoring breakdown is as follows:

• Visuospatial and executive functioning: 5 points
• Animal naming: 3 points
• Attention: 6 points
• Language: 3 points
• Abstraction: 2 points
• Delayed recall (short-term memory): 5 points
• Orientation: 6 points
• Education level: 1 point is added to the test-taker's score if they have 12 years or less of formal education 
  

Advantages vs. Disadvantages

The MoCA is brief, simple, and reliable as a screening test for Alzheimer's disease. It checks executive function, an important part of dementia that's not measured by the MMSE. Unlike the MMSE, it is free for non-profit use.

It is important that this test is done in a patient's first language to be accurate. The MoCA is available in more than 35 languages, but that doesn't mean it will meet everyone's needs. Versions that test people with hearing loss and vision impairment have also been developed.

A disadvantage of the MoCA is that it takes a little longer than the MMSE to administer. It should also be used with multiple other screenings and tests to diagnose dementia.

Summary

Early diagnosis of mental decline is important. The MoCA is a 30-item test that allows healthcare providers to find out how well a person's thinking abilities are functioning.

The MoCA test checks language, memory, visual and spatial thinking, reasoning, and orientation skills. Using it, healthcare providers can quickly determine when someone might need fuller testing for Alzheimer's or dementia.

A Word From Verywell

Being aware of what the MoCA includes and how it's scored can help you better understand its results for you or your loved one.

The MoCA should be given by a healthcare provider and combined with several other assessments. That gives the best, most accurate evaluation of mental functioning to identify possible causes of memory loss.