Over 6 million Americans are currently living with Alzheimer’s disease. And 8 out of 10 Americans are unfamiliar with a condition known as mild cognitive impairment, which may be a warning sign of Alzheimer’s. Detecting dementia early with the help of cognitive evaluations such as the Montreal Cognitive Assessment (MoCA) is key to getting treatment. The MoCA test gives examiners objective insight into your cognitive abilities. If you have a parent or loved one who is older, they may receive a MoCA test when they visit the doctor’s office. Read on for more about what the MoCA test entails.
What Is the MoCA Cognitive Test?
When a person begins to experience signs of cognitive decline, it creates stress and uncertainty in their life and the lives of those who care for them.
Dementia is not the only cause of cognitive issues. But no matter what is causing the impairment, it’s important to understand how an individual’s cognitive function is affected. This will help put an appropriate treatment plan in place.
Discovering the MoCA Cognitive Test
The MoCA cognitive test was developed in Canada during the 1990s. It was published in 2005 by a group of clinicians working at memory clinics in Montreal. They saw the need to standardize cognitive evaluations that detected mild dementia. After its publication, the test was adopted throughout the medical community.
Today, many different types of healthcare providers continue to use the MoCA test, including the following:
- Geriatric psychiatrists and psychologists who primary work with older patients
- Primary care doctors who screen their patients as they age
- Neurologists who focus on treating the brain and disorders of the nervous system
- Nurses
- Family practice physicians who treat general populations
- Occupational therapists who focus on fine motor skills in the context of daily tasks
- Speech-language pathologists who help with speech problems and oral concerns
MoCA Test Health Condition Screening
The MoCA is a helpful screening tool when administered correctly by a doctor in the patient’s first language. The test is available in over 35 different languages.
This evaluation does not diagnose dementia, Alzheimer’s disease, or any other disorders. Instead, it is a screening tool to indicate when further assessment is needed. In addition to Alzheimer’s disease, the MoCA cognitive test also screens for the following conditions:
- Parkinson’s disease, a brain disorder that impacts movement
- Lewy body disease, a disease characterized by an abnormal protein deposits in the brain
- Brain metastasis, which occurs when cancer cells spread from their point of origin into the brain
- Amyotrophic lateral sclerosis, a neurodegenerative condition that affects the spinal cord and brain
- Huntington’s disease, a fatal genetic condition that breaks down cells within the brain
- Vascular cognitive impairment, which can compromise brain function after a stroke
- Sleep behavior disorder, in which a person moves physically to act out their dreams
- Frontotemporal dementia, a form of dementia that causes problems with personality and language
- Multiple sclerosis, a condition in which the nerve sheaths are compromised
- Head trauma, from a minor concussion to a penetrating head wound
- Schizophrenia, a condition that can affect a patient’s perception of the world around them
- Human immunodeficiency virus dementia, which compromises the immune system and leads to cognitive problems
- Brain tumors
- Heart failure
- Substance abuse
- Depression
Early detection leads to better treatment results. MoCA screening can assist with getting faster, more precise treatment plans for those who need them.
How Is the MoCA Performed?
The Montreal Cognitive Assessment tests eight different cognitive domains. It takes approximately 10 minutes to administer. MoCA test questions are straightforward and are not to confuse or mislead the person taking the test.
They include items like reading a list of digits or naming animals shown in a picture. Some domains are tested by a single task, and others are tested with multiple tasks. You won’t be given the domains when you have the MoCA. You’ll just be given the test as a series of tasks.
You will get the test in a doctor’s office or similar environment. You will be seated comfortably across from your doctor. Your family may be able to stay in the room with you while you take the test, depending on your doctor’s policies.
MoCA Cognitive Test Breakdown
The breakdown of the test is as follows:
Visuospatial Ability
In the executive function/visuospatial portion, you will draw a line to show the correct sequence of numbers and letters. You may also copy the drawing of a shape and a clock with the hands set at an indicated time.
Naming
In this section, you will give the names of three animals that are in a picture.
Memory
To test your memory, you will read a list of words and then repeat them. Five minutes later, you will repeat the list a second time.
Attention
You will repeat a list of digits forward and backward. You then identify letters as the doctor speaks them and complete a simple sequence of subtractions.
Language
For language evaluations, you will repeat sentences that are read to you. You then must list words that begin with a specified letter to test your language fluency.
Abstraction
This section includes comparison questions. For example, your doctor might say “banana” and “orange.” You will describe how they are similar; in this case, they are both fruits.
Delayed Recall
Delayed recall is the ability to remember information that was acquired earlier. In this portion, you will recall the words given a few minutes before in the “memory” portion. The doctor records whether you need a cue to recall the words.
Orientation
The last section in the MoCA cognitive test asks you to state the date, month, year, day, place, and city where you are currently located.
Sample MoCA test questions can be found online, along with a MoCA cognitive test printable version. However, it’s important to remember that test results are only considered accurate when the test is given by a trained professional under clinical conditions. It’s also important not to practice or prepare for this test because this can invalidate the test results. The test is meant to be administered without any patient preparation.
Scoring the MoCA Cognitive Test
Each task is then scored, and the points are totaled. The maximum score is 30 points. The breakdown looks like this:
- Visuospatial and executive functioning – 5 points
- Animal naming – 3 points
- Language – 3 points
- Memory and delayed recall – 5 points
- Attention – 6 points
- Orientation – 6 points
- Abstraction – 2 points
A person’s level of education is also factored into your test results. One point is added to the overall score if you completed fewer than 12 years of formal education. This is to help account for the role of cognitive reserve. It is more difficult to tell if someone is losing cognitive ability when they have a higher cognitive baseline due to higher education status.
There are also versions of the MoCA test for individuals who are vision impaired and those with hearing loss. Your doctor will work with you to identify the best MoCA test option for you or your loved one.
What Do Results Mean?
Scores of 26 and over are normal, and a score of 25 or below may indicate cognitive impairment. People with Alzheimer’s disease typically score an average of 16 points at the time of diagnosis. In contrast, people with mild cognitive impairment score an average of 22. A cutoff score of 18 generally differentiates mild cognitive impairment from Alzheimer’s.
Poor performance on the MoCA diagnostic test indicates a cognitive problem. However, it does not determine the root of that problem. A doctor will need to perform a more in-depth diagnostic workup if your MoCA score is low. This may involve more neurocognitive testing and other testing based on the symptoms you have been experiencing. They will also look at which part of the MoCA test was difficult for you to help guide the search for a correct diagnosis.
What Happens Next?
The MoCA cognitive test is quick, simple, and easily accessible for most patients. Even people with severe cognitive issues can complete the assessment with little or no stress. Your doctor can perform a MoCA test to get a clearer picture of your health. A low score on the MoCA typically means you will need more tests. Facing the possibility of Alzheimer’s or other serious cognitive disorders is frightening. However, a clear and early diagnosis leads to the best possible treatment plan. The MoCA cognitive test is important to help you get to the right diagnosis.
Resource Links:
- “2022 Alzheimer’s Disease Facts and Figures” via Alzheimer’s Association
- “Mild Cognitive Impairment” via Medscape
- “The Montreal Cognitive Assessment (MoCA)” via Occupational Medicine
- “The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment” via Journal of the American Geriatrics Society
- “Diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) for cognitive screening in old age psychiatry: Determining cutoff scores in clinical practice. Avoiding spectrum bias caused by healthy controls” via Int J Geriatr Psychiatry
- “Montreal Cognitive Assessment” via MoCA
- “Parkinson’s Disease: Causes, Symptoms, and Treatments” via National Library of Medicine
- “What Is Lewy Body Dementia? Causes, Symptoms, and Treatments” via National Institute on Aging
- “Brain Metastases” via Mayo Clinic
- “Amyotrophic Lateral Sclerosis (ALS)” via Mayo Clinic
- “Overview of Huntington’s Disease” via Huntington’s Disease Society of America
- “Vascular Cognitive Impairment” via Heart & Stroke Foundation
- “REM Sleep Behavior Disorder” via Mayo Clinic
- “Frontotemporal Dementia” via Mayo Clinic
- “Multiple Sclerosis” via Mayo Clinic
- “Head Trauma: First Aid” via Mayo Clinic
- “Schizophrenia” via Mayo Clinic
- “HIV Basics” via Centers for Disease Control and Prevention
