Montreal Cognitive Assessment (MoCA)

Montreal Cognitive Assessment (MoCA)

The Montreal Cognitive Assessment (MoCA) is a rapid screening tool designed to assess mild cognitive dysfunction across various cognitive domains. Authored by Dr. Z. Nasreddine, this document includes detailed administration and scoring instructions for the MoCA version 8.2. It covers tasks related to attention, memory, language, visuoconstructional skills, and orientation. The document is structured into sections that outline specific tasks, scoring criteria, and examples to guide the examiner. It is intended for use by healthcare professionals trained in cognitive assessment, ensuring accurate interpretation of results. The MoCA is widely recognized and utilized in clinical settings to identify cognitive impairments, making this guide an essential resource for practitioners. The document is available in PDF format for easy access and distribution.

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MoCA Version 8.1 June 28, 2017
© Z. Nasreddine MD www.mocatest.org
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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
© Z. Nasreddine MD www.mocatest.org
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• 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
© Z. Nasreddine MD www.mocatest.org
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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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