Montreal Cognitive Assessment (MoCA) Version 8.1

MoCA Version 8.1 June 28, 2017

Montreal Cognitive Assessment (MoCA)

Version 8.1

Administration and Scoring Instructions

The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for

mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration,

executive functions, memory, language, visuoconstructional skills, conceptual thinking,

calculations, and orientation. The MoCA may be administered by anyone who understands and

follows the instructions, however, only a health professional with expertise in the cognitive field

may interpret the results. Time to administer the MoCA is approximately 10 minutes. The total

possible score is 30 points; a score of 26 or above is considered normal.

All instructions may be repeated once.

1. Alternating Trail Making:

Administration: The examiner instructs the subject: "Please draw a line going from a

number to a letter in ascending order. Begin here [point to (1)] and draw a line from 1

then to A then to 2 and so on. End here [point to (E)]."

Scoring: One point is allocated if the subject successfully draws the following pattern:

1- A- 2- B- 3- C- 4- D- 5- E, without drawing any lines that cross. Any error that is not

immediately self-corrected (meaning corrected before moving on to the Cube task)

earns a score of 0. A point is not allocated if the subject draws a line to connect the end

(E) to the beginning (1).

2. Visuoconstructional Skills (Cube):

Administration: The examiner gives the following instructions, pointing to the cube:

“Copy this drawing as accurately as you can.”

Scoring: One point is allocated for a correctly executed drawing.

• Drawing must be three-dimensional.

• All lines are drawn.

• All lines meet with little or no space.

• No line is added.

• Lines are relatively parallel and their length is similar (rectangular prisms are

accepted).

• The cube’s orientation in space must be preserved.

A point is not assigned if any of the above criteria is not met.

3. Visuoconstructional Skills (Clock):

Administration: The examiner must ensure that the subject does not look at his/her watch

while performing the task and that no clocks are in sight. The examiner indicates the

appropriate space and gives the following instructions: “Draw a clock. Put in all the

numbers and set the time to 10 past 11.”

Scoring: One point is allocated for each of the following three criteria:

MoCA Version 8.1 June 28, 2017

• Contour (1 pt.): the clock contour must be drawn (either a circle or a square). Only

minor distortions are acceptable (e.g., slight imperfection on closing the circle). If the

numbers are arranged in a circular manner but the contour is not drawn the contour is

scored as incorrect.

• Numbers (1 pt.): all clock numbers must be present with no additional numbers.

Numbers must be in the correct order, upright and placed in the approximate quadrants on

the clock face. Roman numerals are acceptable. The numbers must be arranged in a

circular manner (even if the contour is a square). All numbers must either be placed inside

or outside the clock contour. If the subject places some numbers inside the clock contour

and some outside the clock contour, (s)he does not receive a point for Numbers.

• Hands (1 pt.): there must be two hands jointly indicating the correct time. The hour hand

must be clearly shorter than the minute hand. Hands must be centered within the clock

face with their junction close to the clock center.

4. Naming:

Administration: Beginning on the left, the examiner points to each figure and says: “Tell

me the name of this animal.”

Scoring: One point is given for each of the following responses: (1) lion (2) rhinoceros or

rhino (3) camel or dromedary.

5. Memory:

Administration: The examiner reads a list of five words at a rate of one per second,

giving the following instructions: “This is a memory test. I am going to read a list of

words that you will have to remember now and later on. Listen carefully. When I am

through, tell me as many words as you can remember. It doesn’t matter in what order you

say them.” The examiner marks a check in the allocated space for each word the subject

produces on this first trial. The examiner may not correct the subject if (s)he recalls a

deformed word or a word that sounds like the target word. When the subject indicates

that (s)he has finished (has recalled all words), or can recall no more words, the examiner

reads the list a second time with the following instructions: “I am going to read the same

list for a second time. Try to remember and tell me as many words as you can, including

words you said the first time.” The examiner puts a check in the allocated space for each

word the subject recalls on the second trial. At the end of the second trial, the examiner

informs the subject that (s)he will be asked to recall these words again by saying: “I will

ask you to recall those words again at the end of the test.”

Scoring: No points are given for Trials One and Two.

6. Attention:

Forward Digit Span: Administration: The examiner gives the following instructions: “I

am going to say some numbers and when I am through, repeat them to me exactly as I

said them.” The examiner reads the five number sequence at a rate of one digit per

second.

Backward Digit Span: Administration: The examiner gives the following instructions:

“Now I am going to say some more numbers, but when I am through you must repeat

MoCA Version 8.1 June 28, 2017

them to me in the backward order.” The examiner reads the three number sequence at a

rate of one digit per second. If the subject repeats the sequence in the forward order, the

examiner may not ask the subject to repeat the sequence in backward order at this point.

Scoring: One point is allocated for each sequence correctly repeated (N.B.: the correct

response for the backward trial is 2-4-7).

Vigilance: Administration: The examiner reads the list of letters at a rate of one per

second, after giving the following instructions: “I am going to read a sequence of letters.

Every time I say the letter A, tap your hand once. If I say a different letter, do not tap

your hand.”

Scoring: One point is allocated if there is zero to one error (an error is a tap on a wrong

letter or a failure to tap on letter A).

Serial 7s: Administration: The examiner gives the following instructions: “Now, I will

ask you to count by subtracting 7 from 100, and then, keep subtracting 7 from your

answer until I tell you to stop.” The subject must perform a mental calculation, therefore,

(s)he may not use his/her fingers nor a pencil and paper to execute the task. The examiner

may not repeat the subject’s answers. If the subject asks what her/his last given answer

was or what number (s)he must subtract from his/her answer, the examiner responds by

repeating the instructions if not already done so.

Scoring: This item is scored out of 3 points. Give no (0) points for no correct

subtractions, 1 point for one correct subtraction, 2 points for two or three correct

subtractions, and 3 points if the subject successfully makes four or five correct

subtractions. Each subtraction is evaluated independently; that is, if the subject responds

with an incorrect number but continues to correctly subtract 7 from it, each correct

subtraction is counted. For example, a subject may respond “92 – 85 – 78 – 71 – 64”

where the “92” is incorrect, but all subsequent numbers are subtracted correctly. This is

one error and the task would be given a score of 3.

7. Sentence repetition:

Administration: The examiner gives the following instructions: “I am going to read you a

sentence. Repeat it after me, exactly as I say it [pause]: I only know that John is the one

to help today.” Following the response, say: “Now I am going to read you another

sentence. Repeat it after me, exactly as I say it [pause]: The cat always hid under the

couch when dogs were in the room.”

Scoring: One point is allocated for each sentence correctly repeated. Repetitions must be

exact. Be alert for omissions (e.g., omitting "only"), substitutions/additions (e.g.,

substituting "only" for "always"), grammar errors/altering plurals (e.g. "hides" for "hid"),

etc.

8. Verbal fluency:

Administration: The examiner gives the following instructions: “Now, I want you to tell

me as many words as you can think of that begin with the letter F. I will tell you to stop

after one minute. Proper nouns, numbers, and different forms of a verb are not permitted.

Are you ready? [Pause] [Time for 60 sec.] Stop.” If the subject names two consecutive

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FAQs of Montreal Cognitive Assessment (MoCA) Version 8.1

What cognitive domains does the MoCA assess?

The Montreal Cognitive Assessment (MoCA) evaluates several cognitive domains, including attention, concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Each of these domains is critical for understanding an individual's cognitive health. By assessing these areas, the MoCA helps identify mild cognitive dysfunction, which can be an early indicator of conditions like Alzheimer's disease or other forms of dementia. The comprehensive nature of the assessment makes it a valuable tool for healthcare professionals.

How is the MoCA administered and scored?

The MoCA is administered by a trained healthcare professional and takes approximately 10 minutes to complete. The assessment includes various tasks, such as drawing a clock, naming animals, and recalling words. Each task is scored, with a maximum possible score of 30 points. A score of 26 or above is considered normal cognitive function, while lower scores may indicate cognitive impairment. The scoring system allows for a nuanced understanding of a patient's cognitive abilities, guiding further evaluation and intervention.

What is the significance of a MoCA score below 26?

A score below 26 on the Montreal Cognitive Assessment (MoCA) suggests potential cognitive impairment, warranting further evaluation. This score indicates that the individual may have difficulties in areas such as memory, attention, or executive function, which are essential for daily living and independence. Clinicians often use this score to determine the need for additional testing or interventions, such as neuropsychological assessments or referrals to specialists. Early identification of cognitive dysfunction can lead to timely support and management strategies.

What tasks are included in the MoCA assessment?

The MoCA assessment includes a variety of tasks designed to evaluate different cognitive functions. These tasks may involve drawing a clock, naming animals, recalling a list of words, and performing simple calculations. Each task targets specific cognitive domains, such as memory, attention, and executive function. For example, the clock-drawing task assesses visuospatial abilities, while the word recall task evaluates memory retention. The diverse range of tasks ensures a comprehensive assessment of cognitive health.

Montreal Cognitive Assessment (MoCA) Version 8.1

Key Points

FAQs of Montreal Cognitive Assessment (MoCA) Version 8.1

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