TOTAL SCORE ( /30)
Name ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ Sex
͟ ͟ ͟ ͟ ͟ Age
͟ ͟ ͟
Education ͟ ͟ ͟ Date of exam ͟ ͟ ͟ ͟ ͟
Administered by ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟ ͟
SCORE
MONTREAL COGNITIVE ASSESSMENT (MOCA-B)
BASIC
Adapted by : Parunyou Julayanont MD Copyright : Z. Nasreddine MD Final Version June 04, 2014
VISUOPERCEPTION scissors T-shirt banana lamp candle
watch cup leaf key spoon
3 points if N = 9-10
2 points if N = 6-8
1 point if N = 4-5
0 point if N = 0-3
N ͟
( /3)
EXECUTIVE FUNCTION
( /1)
IMMEDIATE RECALL No point
Perform 2 trials even if 1st trial is successful
ROSE
CHAIR
HAND
BLUE
SPOON
1st trial
2nd trial
[ ] time (± 2 hr) [ ] day [ ] month [ ] year [ ] place [ ] city
ORIENTATION
( /6)
( /2)
FLUENCY
2 points if N =13 or more
1 point if N = 8-12
0 point if N = 7 or less
N items Name maximum numbers of FRUITS in 1 minute
1.…………. 2.……………. 3.…………….
4.…………....
5.……………
6.……………
7.…………. 8.……………. 9.…………….
10.………….... 11.…………… 12.……………
13.…………. 14.……………. 15.…………….
16.…………....
17.……………
18.……………
ABSTRACTION
( /3)
To what categorythese objects belong to ? ( e.g. orange - banana = fruit )
[ ] train - boat [ ] north - south [ ] drum - flute
ERROR ͟ ͟ N No point if 2 errors or more
ATTENTION ( /1)
1 5 8 3 9 2 0 3 9 4 0 2 1 6 8 7 4 6 7 5
Identify drawings. No more than 60 seconds. See complementary sheet.
( /4)
NAMING Identify animals. See complementary sheet. [ ] zebra [ ] peacock [ ] tiger [ ] butterfly
START
TIME
TOTAL TIME ͟ ͟ ͟ ͟ ͟ min ͟ ͟ ͟ ͟ ͟ sec
Provide 3 ways to pay using1 dollar coins, 5 dollar and 10 dollar bills for an object that costs exactly
“13 Dollars”
[ ] 1……………………………
[ ] 2. …………………………
[ ] 3. …………………………
( /3)
CALCULATION
(3 points if 3 ways, 2 points if 2 ways, 1 point if 1 way, 0point if no correct way)
Recall with
No cue
ROSE
[ ]
CHAIR
[ ]
HAND
[ ]
BLUE
[ ]
SPOON
[ ]
Recall with category cue
[ ]
[ ]
[ ]
[ ]
[ ]
Recall with
multiple choice cue
[ ]
[ ]
[ ]
[ ]
[ ]
DELAYED RECALL
( /5)
Points are awarded for
recall with No cue (1point for each item)
Name the numbers in circles.
See complementary sheet.
Name the numbers in circles & squares:
3 8 5 1 3 0 2 9 2 0 4 9 7 8 6 1 5 7 6 4
See complementary sheet.
1 5 8 3 9 2 0 3 9 4 0 2 1 6 8 7 4 6 7 5
ERROR ͟ ͟ N
2 points if 2 errors or less
1 point if 3 errors
0 point if 4 errors or more
( /2)
END TIME
Add 1 point if education < 4 year AND add 1 point if illiterate
