MoCA Form

The Montreal Cognitive Assessment (MoCA) is a widely used screening tool designed to assess cognitive function in various domains, including memory, attention, language, and visuospatial skills. Developed by Dr. Ziad Nasreddine, this assessment is crucial for identifying cognitive impairments in patients, particularly in clinical settings. The MoCA test includes tasks such as word recall, serial subtraction, and drawing a clock, making it a comprehensive tool for healthcare professionals. Ideal for neurologists, psychologists, and general practitioners, the MoCA is essential for evaluating cognitive decline and dementia. This version provides clear instructions and scoring guidelines to facilitate accurate assessments.

Key Points

Evaluates cognitive abilities across multiple domains including memory, language, and attention.
Includes tasks such as word recall, serial subtraction, and clock drawing.
Developed by Dr. Ziad Nasreddine for clinical assessment of cognitive impairment.
Essential for healthcare professionals assessing patients for dementia and cognitive decline.

362

POINTS

TOTAL

M E M O R Y

N A M I N G

VISUOSPATIAL / EXECUTIVE

ATTENTION

LANGUAGE

ABSTRACTION

DELAYED RECALL

ORIENTATION

Read list of words, subject

mus

t repeat them. Do 2 trials.

Do a

recall after 5 minutes.

Subject has to repeat them in the forward order [ ] 2 1 8 5 4

Subject has to repeat them in the backward order

[ ] 7 4 2

Read list of letters. The subject must tap with his hand at each letter A.

No points if ≥ 2 errors

[ ]

F B A C M N A A J K L B A F A K D E A A A J A M O F A A B

Serial 7 subtraction starting at 100 [ ] 93 [ ] 86 [ ] 79 [ ] 72 [ ] 65

Repeat : I only know that John is the one to help today. [ ]

The cat always hid under the couch when dogs were in the room. [ ]

Similarity between e.g. banana - orange = fruit

[ ] train – bicycle [ ] watch - ruler

Draw CLOCK (Ten past eleven)Copy

cube

__/5

__/3

points

1st trial

2nd trial

FACE

LVET

CHURCH

DAISY RED

__/5

__/2

__/1

__/3

__/2

Fluency / Name maximum number of words in one minute that begin with the letter F

_____ [ ] (N ≥ 11 words)

__/1

__/2

__/6

__/30

Begin

End

Read list of digits (1 digit/ sec.).

NAME :

Education :

Sex :

Date of birth :

DATE :

www.mocatest.org

Normal ≥ 26 / 30

Add 1 point if

≤ 12 yr edu

MONTREAL COGNITIVE ASSESSMENT (MOCA)

[ ] Date [ ] Month [ ] Year [ ] Day [ ] Place [ ] City

[ ]

Contour

[ ][ ] [ ]

Numbers

[ ]

Hands

[ ] [ ] [ ]

4 or 5 correct subtractions: 3 pts, 2 or 3 correct: 2 pts, 1 correct: 1 pt, 0 correct: 0 pt

( 3 poi

nts )

Category cue

Points for

UNCUED

recall only

WITH NO CUE

Optional

Has to recall words

Multiple choice

cue

FACE

LVET

CHURCH

DAISY

RED

[ ] [ ] [ ] [ ] [ ]

Administered by: ___________________________________________________

362

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FAQs of MoCA Form

What cognitive domains does the MoCA assess?

The Montreal Cognitive Assessment evaluates several cognitive domains, including memory, attention, language, visuospatial skills, and executive functions. Each domain is tested through specific tasks, such as recalling words, performing serial subtractions, and drawing a clock. This comprehensive approach helps healthcare professionals identify areas of cognitive impairment and provides a clearer picture of a patient's overall cognitive health.

How is the MoCA scored?

The MoCA is scored out of a total of 30 points, with a score of 26 or higher typically considered normal. Each section of the assessment contributes different points, and specific tasks have designated scoring criteria. For instance, the word recall section allows for a maximum of five points, while the clock drawing task is worth three points. Scoring guidelines are provided to ensure accurate evaluation of cognitive function.

Who can administer the MoCA test?

The MoCA test can be administered by various healthcare professionals, including neurologists, psychologists, and general practitioners. It is designed to be easy to administer and can be conducted in a clinical setting or during routine check-ups. Training is not required, but familiarity with the scoring criteria and tasks is beneficial for accurate assessment and interpretation of results.

What is the purpose of the MoCA?

The primary purpose of the Montreal Cognitive Assessment is to screen for cognitive impairment and to assist in the early detection of conditions such as dementia and Alzheimer's disease. By evaluating multiple cognitive domains, the MoCA provides a comprehensive overview of a patient's cognitive health, allowing for timely intervention and management. It is especially useful in settings where cognitive decline is a concern, such as geriatric care and neurology.