Montreal Cognitive Assessment

The Montreal Cognitive Assessment (MoCA) was created in 1996 by Ziad Nasreddine in Montreal, Quebec. It was validated in the setting of mild cognitive impairment, and has subsequently been adopted in numerous other settings clinically.

Format

The MoCA test is a one-page 30-point test administered in approximately 10 minutes. The test and administration instructions are available for clinicians online. The test is available in 55 languages or dialects. There are alternate forms designed for use in longitudinal settings. There is also a basic form to test illiterate or subjects with lower education.

The MoCA assesses several cognitive domains. The short-term memory recall task (5 points) involves two learning trials of five nouns and delayed recall after approximately 5 minutes. Visuospatial abilities are assessed using a clock-drawing task (3 points) and a three-dimensional cube copy (1 point). Multiple aspects of executive functions are assessed using an alternation task adapted from the trail-making B task (1 point), a phonemic fluency task (1 point), and a two-item verbal abstraction task (2 points). Attention, concentration and working memory are evaluated using a sustained attention task (target detection using tapping; 1 point), a serial subtraction task (3 points), and digits forward and backward (1 point each). Language is assessed using a three-item confrontation naming task with low-familiarity animals (lion, camel, rhinoceros; 3 points), repetition of two syntactically complex sentences (2 points), and the aforementioned fluency task. Finally, orientation to time and place is evaluated (6 points).

Because MoCA is English specific, linguistic and cultural translations are made in order to adapt the test in other countries. Multiple cultural and linguistic variables may affect the norms of the MoCA across different countries and languages. Several cut-off scores have been suggested across different languages to compensate for education level of the population, and several modifications were also necessary to accommodate certain linguistic and cultural differences across different languages/countries. However, not all versions have been validated.

Efficacy

MoCA test study

A MoCA test validation study by Nasreddine in 2005 showed that the MoCA was a promising tool for detecting Mild Cognitive Impairment (MCI) and Early Alzheimer's disease compared with the well-known Mini-Mental State Examination (MMSE).[1] However, it had been established that the MMSE is not well suited for mild cognitive impairment, which raises the question whether it is an adequate "standard" to compare performance with the MoCA.

According to the validation study, the sensitivity and specificity of the MoCA for detecting MCI were 90% and 87% respectively, compared with 18% and 100% respectively for the MMSE. Subsequent studies in other settings were less promising, though generally superior to the MMSE.

Other studies have tested the MoCA on patients with Alzheimer's disease.[2][3][4]

Recommendations

The National Institutes of Health and the Canadian Stroke Network recommended selected subsets of the MoCA for the detection of vascular cognitive impairment.[5]

Other applications

Since the MoCA assesses multiple cognitive domains, it may be a useful cognitive screening tool for several neurological diseases that affect younger populations, such as Parkinson's disease,[6][7][8] vascular cognitive impairment,[9][10] Huntington's disease,[11] brain metastasis, sleep behaviour disorder,[12] primary brain tumors (including high and low grade gliomas),[13] multiple sclerosis and other conditions such as traumatic brain injury, depression, schizophrenia[14] and heart failure.

References

  1. ↑ Nasreddine, Ziad S.; Phillips, Natalie A.; Bédirian, Valérie; Charbonneau, Simon; Whitehead, Victor; Collin, Isabelle; Cummings, Jeffrey L.; Chertkow, Howard (2005-04-01). "The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment". Journal of the American Geriatrics Society. 53 (4): 695–699. doi:10.1111/j.1532-5415.2005.53221.x. ISSN 0002-8614. PMID 15817019.
  2. ↑ Fujiwara, Yoshinori; Suzuki, Hiroyuki; Yasunaga, Masashi; Sugiyama, Mika; Ijuin, Mutsuo; Sakuma, Naoko; Inagaki, Hiroki; Iwasa, Hajime; Ura, Chiaki (2010-07-01). "Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment". Geriatrics & Gerontology International. 10 (3): 225–232. doi:10.1111/j.1447-0594.2010.00585.x. ISSN 1447-0594. PMID 20141536.
  3. ↑ Guo, Qi-Hao; Cao, Xin-Yi; Zhou, Yan; Zhao, Qian-Hua; Ding, Ding; Hong, Zhen (2010-02-01). "Application study of quick cognitive screening test in identifying mild cognitive impairment". Neuroscience Bulletin. 26 (1): 47–54. doi:10.1007/s12264-010-0816-4. ISSN 1995-8218. PMID 20101272.
  4. ↑ Luis, Cheryl A.; Keegan, Andrew P.; Mullan, Michael (2009-02-01). "Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US". International Journal of Geriatric Psychiatry. 24 (2): 197–201. doi:10.1002/gps.2101. ISSN 1099-1166. PMID 18850670.
  5. ↑ Hachinski, Vladimir; Iadecola, Costantino; Petersen, Ron C.; Breteler, Monique M.; Nyenhuis, David L.; Black, Sandra E.; Powers, William J.; DeCarli, Charles; Merino, Jose G. (2006-09-01). "National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards". Stroke; a Journal of Cerebral Circulation. 37 (9): 2220–2241. doi:10.1161/01.STR.0000237236.88823.47. ISSN 1524-4628. PMID 16917086.
  6. ↑ Dalrymple-Alford, J. C.; MacAskill, M. R.; Nakas, C. T.; Livingston, L.; Graham, C.; Crucian, G. P.; Melzer, T. R.; Kirwan, J.; Keenan, R. (2010-11-09). "The MoCA: well-suited screen for cognitive impairment in Parkinson disease". Neurology. 75 (19): 1717–1725. doi:10.1212/WNL.0b013e3181fc29c9. ISSN 1526-632X. PMID 21060094.
  7. ↑ Kasten, Meike; Bruggemann, Norbert; Schmidt, Alexander; Klein, Christine (2010-08-03). "VALIDITY OF THE MoCA AND MMSE IN THE DETECTION OF MCI AND DEMENTIA IN PARKINSON DISEASE". Neurology. 75 (5): 478–479. doi:10.1212/WNL.0b013e3181e7948a. ISSN 0028-3878. PMID 20679642.
  8. ↑ Hoops, S; Nazem, S; Siderowf, A D.; Duda, J E.; Xie, S X.; Stern, M B.; Weintraub, D (2009-11-24). "Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease". Neurology. 73 (21): 1738–1745. doi:10.1212/WNL.0b013e3181c34b47. ISSN 0028-3878. PMC 2788810Freely accessible. PMID 19933974.
  9. ↑ Cameron, Jan; Worrall-Carter, Linda; Page, Karen; Riegel, Barbara; Lo, Sing Kai; Stewart, Simon (2010-05-01). "Does cognitive impairment predict poor self-care in patients with heart failure?". European Journal of Heart Failure. 12 (5): 508–515. doi:10.1093/eurjhf/hfq042. ISSN 1879-0844. PMID 20354031.
  10. ↑ Wong, Adrian; Xiong, Yun Y.; Kwan, Pauline W. L.; Chan, Anne Y. Y.; Lam, Wynnie W. M.; Wang, Ki; Chu, Winnie C. W.; Nyenhuis, David L.; Nasreddine, Ziad (2009-01-01). "The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease". Dementia and Geriatric Cognitive Disorders. 28 (1): 81–87. doi:10.1159/000232589. ISSN 1421-9824. PMID 19672065.
  11. ↑ Videnovic, Aleksandar; Bernard, Bryan; Fan, Wenqing; Jaglin, Jeana; Leurgans, Sue; Shannon, Kathleen M. (2010-02-15). "The Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in Huntington's disease". Movement Disorders: Official Journal of the Movement Disorder Society. 25 (3): 401–404. doi:10.1002/mds.22748. ISSN 1531-8257. PMID 20108371.
  12. ↑ Bertrand, Josie-Anne; Marchand, Daphné Génier; Postuma, Ronald B.; Gagnon, Jean-François (2016-07-28). "Cognitive dysfunction in rapid eye movement sleep behavior disorder". Sleep and Biological Rhythms. 11 (1): 21–26. doi:10.1111/j.1479-8425.2012.00547.x. ISSN 1446-9235.
  13. ↑ Olson, Robert Anton; Chhanabhai, Taruna; McKenzie, Michael (2008-11-01). "Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases". Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer. 16 (11): 1273–1278. doi:10.1007/s00520-008-0431-3. ISSN 0941-4355. PMID 18335256.
  14. ↑ Fisekovic, Saida; Memic, Amra; Pasalic, Alma (2012-09-01). "CORRELATION BETWEEN MOCA AND MMSE FOR THE ASSESSMENT OF COGNITION IN SCHIZOPHRENIA". Acta Informatica Medica. 20 (3): 186–189. doi:10.5455/aim.2012.20.186-189. ISSN 0353-8109. PMC 3508854Freely accessible. PMID 23322976.
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