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Montreal cognitive assessment (MoCA) tool

Indications: - brief cognitive screening tool with high sensitivity & specificity for detecting mild cognitive impairment (MCI) [1] - MoCA-B is useful for illiterate & low-education patients [5] - MoCA-H is useful for people with hearing impairment [8] Clinical significance: - best alternative to MMSE for evaluation of MCI [3] - predictive of conversion from MCI to Alzheimer's disease (AD) - cutoff scores: - a score of < 26/30 suggests cognitive impairment [4] - < 23 commonly used for dementia cutoff [9] - 20 out of 30 for MoCA-TS & 7 out of 15 for MoCA-MIS - 1-point educational correction to cutoff scores because MoCA has been determined to be influenced by education & cultural factors - in a population of 231 community-dwelling older adults (>64 years), using uncorrected MoCa scores, 39% classified with normal cognition, 58% with mild cognitive impairment MCI), & 3% with dementia [9] - after applying the 1 point correction, 10% with normal cognition, 52% with MCI, 38% with dementia [9] - optimal sensitivity & specificity for cognitive impairment (MCI or dementia) achieved when the MoCA cutpoint is set at 16.5 [9] - annual conversion rate from MCI to AD is 60% for MoCA-MIS < 7 & 35% for MoCA-MIS >= 7 [2]* * It is difficult to reconcile this estimate with that from MKSAP (see minimal cognitive impairment) Notes: - MoCA became proprietary in September of 2019 [6] - users must be trained & certified for a fee of $125 & re-certify every 2 years - users must register a unique profile, obtain consent, & enter selected patient data & test results through an online portal [6] - conversion between the Montreal Cognitive Assessment & the Mini-Mental Status Examination [7]

General

mental status examination (MSE)

References

  1. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S et al The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. PMID: 15817019
  2. Julayanont, P, Brousseay M, Chertkow H, et al. Montreal Cognitive Assessment Memory Index Score (MoCA-MIS) as a predictor of conversion from mild cognitive impairment to Alzheimer's disease. J Am Geriatr Soc. 2014;62:679-684. PMID: 24635004
  3. Tsoi KK et al Cognitive Tests to Detect Dementia. A Systematic Review and Meta-analysis. JAMA Intern Med. Published online June 08, 2015. PMID: 26052687 http://archinte.jamanetwork.com/article.aspx?articleID=2301149
  4. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
  5. Julayanont P, Tangwongchai S, Hemrungrojn S et al The Montreal Cognitive Assessment-Basic: A Screening Tool for Mild Cognitive Impairment in Illiterate and Low-Educated Elderly Adults. J Am Geriatr Soc. 2015 Dec;63(12):2550-2554. Epub 2015 Dec 9. PMID: 26648041
  6. American Geriatrics Society. Dec 2019 Monetizing the MoCA
  7. Fasnacht JS et al. Conversion between the Montreal Cognitive Assessment and the Mini-Mental Status Examination. J Am Geriatr Soc 2023 Mar; 71:869 PMID: 36346002 Free article https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18124
  8. Dawes P, Reeves D, Yeung WK et al Development and validation of the Montreal cognitive assessment for people with hearing impairment (MoCA-H) J Am Geriatr Soc. 2023 May;71(5):1485-1494 PMID: 36722180 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.18241
  9. Stimmel MB et al. Is the Montreal cognitive assessment culturally valid in a diverse geriatric primary care setting? Lessons from the Bronx. J Am Geriatr Soc 2024 Mar; 72:850 PMID: 38196332 PMCID: PMC10947962 (available on 2025-03-01) https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18705
  10. Montreal Cognitive Assessment http://www.mocatest.org