Montreal Cognitive Assessment (MoCA): Concept and Clinical Review

Abstract

The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument developed to detect mild cognitive impairment (MCI). It is a simple 10 min paper and pencil test that assesses multiple cognitive domains including memory, language, executive functions, visuospatial skills, calculation, abstraction, attention, concentration, and orientation. Its validity has been established to detect mild cognitive impairment in patients with Alzheimer’s disease and other pathologies in cognitively impaired subjects who scored in the normal range on the MMSE. MoCA’s sensitivity and specificity to detect subjects with MCI due to Alzheimer’s disease and distinguish them from healthy controls are excellent. MoCA is also sensitive to detect cognitive impairment in cerebrovascular disease and Parkinson’s disease, Huntington’s disease, brain tumors, systemic lupus erythematosus, substance use disorders, idiopathic rapid eye movement sleep behavior disorder, obstructive sleep apnea, risk of falling, rehabilitation outcome, epilepsy, chronic obstructive pulmonary disease and human immunodeficiency virus infection. There are several features in MoCA’s design that likely explain its superior sensitivity for detecting MCI. MoCA’s memory testing involves more words, fewer learning trials, and a longer delay before recall than the MMSE. Executive functions, higher-level language abilities, and complex visuospatial processing can also be mildly impaired in MCI participants of various etiologies and are assessed by the MoCA with more numerous and demanding tasks than the MMSE. MoCA was developed in a memory clinic setting and normed in a highly educated population. A new version of the MoCA called MoCA-Basic (MoCA-B) was developed to fulfill the limitation of the MoCA among the low educated and illiterate population. MoCA Memory Index Score is a newly devised score that can help clinicians better predict which patients with MCI are most likely to convert to dementia. The MoCA is freely accessible for clinical and educational purposes (www.mocatest.org), and is available in 56 languages and dialects.