MoCA Cognitive Screening Reference

The Montreal Cognitive Assessment (MoCA) is a widely used, validated brief cognitive screening instrument designed to detect mild cognitive impairment (MCI) and early dementia. It was developed by Dr. Ziad Nasreddine and colleagues in Montreal and first published in 2005. The MoCA takes approximately 10 minutes to administer and covers seven cognitive domains: visuospatial and executive function (5 points, including a trail-making task, clock drawing, and three-dimensional cube copying), naming (3 points, identifying three animals from drawings), memory (delayed recall of 5 words — scored 0 during learning but recalled later for up to 5 points total), attention (6 points, including digit span forward and backward, a sustained attention task, and a serial subtraction task), language (3 points, sentence repetition and verbal fluency), abstraction (2 points, identifying the similarity between two objects), and orientation (6 points, date, month, year, day, place, and city). The maximum score is 30, with 26 or above considered normal. One point is added for patients with 12 or fewer years of formal education. Scores of 18-25 suggest mild cognitive impairment, 10-17 indicate moderate cognitive impairment, and below 10 reflect severe cognitive impairment. Compared to the Mini-Mental State Examination (MMSE), the MoCA is significantly more sensitive for detecting mild cognitive impairment and is therefore the preferred screening tool in most neurology clinics and memory services.

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1. 1Administer the visuospatial/executive section: trail-making (1pt), cube copy (1pt), clock drawing with number placement and hands (3pts).
2. 2Present three animal pictures (lion, camel/dromedary, rhinoceros) for naming (1pt each, max 3pts).
3. 3Read five words for memory registration — no points at this stage; words are recalled later for the delayed recall score.
4. 4Test attention: forward digit span 5-2-1-9-3 (1pt), backward digit span 7-4-2 (1pt), sustained attention tap-on-A task (1pt), serial subtraction 93-7 (0-3pts based on errors).
5. 5Test language: repeat two complex sentences exactly (1pt each), and name as many words beginning with 'F' as possible in 1 minute — 11 or more words scores 1pt.
6. 6Test abstraction by asking how a train and bicycle are alike (1pt) and how a watch and ruler are alike (1pt).
7. 7Test delayed recall of the five words from the memory section (1pt per word recalled without cues); then score orientation to date, month, year, day of week, place, and city (1pt each). Add 1pt if education ≤12 years. Total out of 30.

• !Administering MoCA to a delirious or acutely unwell patient and using the score to diagnose dementia.
• !Forgetting to apply the education correction point for patients with 12 or fewer years of schooling.
• !Not administering the full standardised form — some clinicians adapt or shorten the test, which invalidates comparison with published norms.
• !Using MoCA as a standalone dementia diagnostic tool rather than as a screening test requiring follow-up investigation.
• !Scoring the delayed recall section with category cues included in the total — cued recall does not score full points on standard MoCA.
• !Failing to document the administration conditions (quiet room, glasses, hearing aids in place) which significantly affect performance.