Table of ContentsView AllTable of ContentsGoals of TestingHow It WorksMoCA vs. MMSEInterpretationPros and ConsAccuracyAlternatives
Table of ContentsView All
View All
Table of Contents
Goals of Testing
How It Works
MoCA vs. MMSE
Interpretation
Pros and Cons
Accuracy
Alternatives
The Montreal Cognitive Assessment (MoCA) is a test used to detect mild cognitive decline and early signs of dementia. It can help identify people at risk ofAlzheimer’s diseaseand screen for conditions likeParkinson’s disease,brain tumors, substance abuse, and head trauma.
Introduced in 2005, the MoCA test is an update from the olderMini-Mental State Examination (MMSE)introduced in 1975. It contains 30 questions and takes 10 minutes to complete. While the MOCA test is useful in detecting dementia, it cannot differentiate between the differentdementia types.
There are advantages and disadvantages of this important screening tool. On the one hand, it is simple and quick to administer; on the other, training is needed to properly administer the test, and a person’s education level can influence the results.
Verywell / Brianna Gilmartin
Purpose of the MoCA Test
The MoCA test is a simple, in-office tool that can quickly determine if there is any impairment in a person’scognitive function, including their ability to understand, reason, and remember.
The test is used for adults 55 to 85 withearly signs of dementia(the progressive loss of intellectual functioning, especially memory and abstract thinking).
If the test indicates that a person hasmild cognitive impairment (MCI), additional evaluations may be done to check for suspected causes, like:
The MoCA test can also check for MCI in people with known conditions such as:
How Common Is Dementia?According to the Centers for Disease Control and Prevention (CDC), around 5.8 million people in the United States have Alzheimer’s disease and relateddementias. Over 95% of those affected are 65 or older. By 2060, the number of Alzheimer’s cases is predicted to rise to 14 million.
How Common Is Dementia?
According to the Centers for Disease Control and Prevention (CDC), around 5.8 million people in the United States have Alzheimer’s disease and relateddementias. Over 95% of those affected are 65 or older. By 2060, the number of Alzheimer’s cases is predicted to rise to 14 million.
How the MoCA Works
The MoCA test is based on scores with a maximum score of 30. It takes 10 to 12 minutes to complete.
The MoCA test examines seven domains (aspects) of cognitive function with several exercises and tasks:
The MoCA is similar to an older test called the Mini-Mental State Exam (MMSE). Both tests use a 30-point scale and take only a few minutes to complete.
Both the MoCA and MMSE have their benefits, limitations, and uses:
On their own, neither test can diagnose the cause of cognitive impairment or dementia.
MoCASeveral questions with a maximum score of 30Evaluates 7 domains of cognition(executive/visuospatial function, naming, attention, language, abstraction, recall, and orientation)A score of less than 26 indicates mild cognitive impairmentTake around 10 to 12 minutes to completeQuestions are more difficultHas a higher sensitivity for mild cognitive impairment but less value for people with moderate to severe dementiaBetter at detecting early dementiaMMSE11 questions with a maximum score of 30Evaluate 5 domains of cognition (orientation, registration, attention/calculation, recall, and language)A score of less than 25 indicates mild cognitive impairmentTakes around 7 to 8 minutes to completeQuestions are less difficultHas a lower sensitivity for mild cognitive impairment but is able to monitor for subtle changes in people with moderate to severe dementiaBetter at monitoring people with known dementia
MoCASeveral questions with a maximum score of 30Evaluates 7 domains of cognition(executive/visuospatial function, naming, attention, language, abstraction, recall, and orientation)A score of less than 26 indicates mild cognitive impairmentTake around 10 to 12 minutes to completeQuestions are more difficultHas a higher sensitivity for mild cognitive impairment but less value for people with moderate to severe dementiaBetter at detecting early dementia
Several questions with a maximum score of 30
Evaluates 7 domains of cognition
(executive/visuospatial function, naming, attention, language, abstraction, recall, and orientation)
A score of less than 26 indicates mild cognitive impairment
Take around 10 to 12 minutes to complete
Questions are more difficult
Has a higher sensitivity for mild cognitive impairment but less value for people with moderate to severe dementia
Better at detecting early dementia
MMSE11 questions with a maximum score of 30Evaluate 5 domains of cognition (orientation, registration, attention/calculation, recall, and language)A score of less than 25 indicates mild cognitive impairmentTakes around 7 to 8 minutes to completeQuestions are less difficultHas a lower sensitivity for mild cognitive impairment but is able to monitor for subtle changes in people with moderate to severe dementiaBetter at monitoring people with known dementia
11 questions with a maximum score of 30
Evaluate 5 domains of cognition (orientation, registration, attention/calculation, recall, and language)
A score of less than 25 indicates mild cognitive impairment
Takes around 7 to 8 minutes to complete
Questions are less difficult
Has a lower sensitivity for mild cognitive impairment but is able to monitor for subtle changes in people with moderate to severe dementia
Better at monitoring people with known dementia
Scoring the MoCA Test
The total score on the MoCA test ranges from 0 to 30. The scoring per domain is broken downs as follows:
Because a person’s education can limit their comprehension of certain tasks,1 pointis added to the total score if a person has 12 years or less of formal education.
Interpreting the Results
After tallying the MoCA scores, the results can be interpreted as follows:
Advantages vs. Disadvantages
Among the advantages of the MoCA test:
Among the disadvantages of the MoCA test:
How Accurate Is the MoCA Test?
The MoCA test is generally better at detecting MCI and early dementia than the MMSE test. This is based on comparisons of thesensitivity(the ability to correctly identify people with a disease) andspecificity(the ability to correctly identify people without a disease) of both tests.
A 2015 study published inBMC Geriatricsreported that the MoCA has a sensitivity and specificity of 90% and 87% respectively in detecting MCI. By contrast, the MMSE has a sensitivity and specificity of 18% and 100%. The MMSE was only better at detecting when someone doesn’t have MCI.
Can You Pass the MoCA and Still Have Dementia?While the MoCA test is an important tool for the diagnosis of early dementia, it is not perfect. A test sensitivity of 90% means that the MoCA will return afalse-negativeresult in roughly one of every 10 cases.For this reason, the MoCA is commonly used alongside other cognitive tests with ongoing evaluations to check for signs of decline. As a standalone test, the MoCA may not be enough to make a firm decision about a person’s cognitive health, particularly if the results are borderline.
Can You Pass the MoCA and Still Have Dementia?
While the MoCA test is an important tool for the diagnosis of early dementia, it is not perfect. A test sensitivity of 90% means that the MoCA will return afalse-negativeresult in roughly one of every 10 cases.For this reason, the MoCA is commonly used alongside other cognitive tests with ongoing evaluations to check for signs of decline. As a standalone test, the MoCA may not be enough to make a firm decision about a person’s cognitive health, particularly if the results are borderline.
While the MoCA test is an important tool for the diagnosis of early dementia, it is not perfect. A test sensitivity of 90% means that the MoCA will return afalse-negativeresult in roughly one of every 10 cases.
For this reason, the MoCA is commonly used alongside other cognitive tests with ongoing evaluations to check for signs of decline. As a standalone test, the MoCA may not be enough to make a firm decision about a person’s cognitive health, particularly if the results are borderline.
Alternatives to the MoCA Test
The MoCA test is one of the most widely used tests for detecting dementia, but there are others that are sometimes used to detect mild neurocognitive impairment and the early signs of dementia.
SLUMS Examination
TheSaint Louis University Mental Status (SLUMS) Examinationis a screening test for Alzheimer’s disease and other kinds of dementia. It is an alternative to the more widely used MoCA and MMSE and consists of 11 questions that help a healthcare provider evaluate skills like:
The various questions are scored from 0 to 5, with a maximum score of 30. A score of 0 to 20 indicates dementia, while a score of 21 to 26 indicates mild neurocognitive impairment. Anything over 26 is considered normal.
Studies have shown that the SLUMS test has a similar reliability to the MoCA in detecting early signs of dementia.Others suggest that it may be far superior to the MMSE in doing the same.
The SLUMS test has also proven superior to the MoCA and MMSE in the detection of cognitive impairment in people with atraumatic brain injury (TBI). Because the SLUMs test is slightly more demanding (requiring basic math skills), it may be more sensitive to changes outside of the realm of aging-associated conditions like Alzheimer’s.
ADAS-Cog Test
TheAlzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog)is used to diagnose the severity of dementia in people already diagnosed with dementia. The ADAS-Cog is the standard most commonly used in clinical trials and is considered the gold standard for assessing a person’s response toAlzheimer’s treatments.
The ADAS-Cog consists of 11 parts that assess skills like:
The various questions are scored from 1 to 5, with a maximum score of 70. Higher scores indicate worse cognitive dysfunction. Scores of at least 18 indicate cognitive impairment.
The ADAS-Cog requires high levels of training for the results to be qualitative.
SPMSQ Tool
The Short Portable Mental Status Questionnaire (SPMSQ) is a simple test that doesn’t require any writing or drawing. It can be administered anywhere and consists of 10 standard questions:
The SPMSQ is evaluated based on the number of errors you make as follows: 0-2 errors (normal), 3-4 errors (mild impairment), 5 -7 errors (moderate impairment), and 8 or more errors (severe impairment).
For the assessment of mild neurocognitive impairment, some studies have shown that the ADAS-Coq is comparable to the MoCA in reliability.
However, researchers with the U.S. Preventive Services Task Force (USPSTF) argue that the SPMSQ has a lack of studies evidencing its effectiveness or that it is unclear how useful the evaluation is make clinical decision-making.
CAM Assessment
The Confusion Assessment Method (CAM) is an evaluation used to assessdelirium. Delirium is similar to dementia, but it is not the same.
Delirium can be diagnosed based on the CAM test if the following criteria are met:
The other symptoms (such as impaired thinking and psychomotor retardation) may be useful in characterizing delirium and measuring the response to treatment.
The CAM assessment can help determine if the symptoms a person is experiencing are unrelated to Alzheimer’s and are, in fact, treatable
Summary
The MoCA test is a simple, in-office test that can detect mild cognitive impairment and the early onset of dementia. It does so based on 11 questions that evaluate seven domains of cognitive function. The MoCA has a maximum score of 30, and anything below 26 is a sign of cognitive impairment.
How Accurate Is the BIMS in Detecting Dementia?
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Gluhm A, Goldstein J, Loc K, Colt A, Van Liew C, Corey-Bloom M.Cognitive performance on the Mini-Mental State Examination and the Montreal Cognitive Assessment across the healthy adult lifespan.Cogn Behav Neurol.2013 Mar;26(1):1–5. doi:10.1097/WNN.0b013e31828b7d26
Centers for Disease Control and Prevention.Minorities and women are at greater risk for Alzheimer’s disease.
Kim H, Yu KH, Lee BC, Kim BC, Kang Y.Validity of the Montreal Cognitive Assessment (MoCA) index scores: a comparison with the cognitive domain scores of the Seoul Neuropsychological Screening Battery (SNSB).Dement Neurocogn Disord. 2021;20(3):28-37. doi:10.12779/dnd.2021.20.3.28
Trzepacz PT, Hochstelter H, Wang S, Walker B, Saykin AJ.Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults.BMC Geriatr.2015;15:107. doi:10.1186/s12877-015-0103-3
Islam N, Rashem R, Gad M, et al.Accuracy of the Montreal Cognitive Assessment tool for detecting mild cognitive impairment: a systematic review and meta-analysis.Alzheimer Dementia.2023;19(7):3235-3243. doi:10.1002/alz.13040
St. Louis University Medical School.VAMC SLUMS examination.
Lee YC, Lin YT, Chiu EC.A comparison of test-retest reliability of four cognitive screening tools in people with dementia.Disabil Rehabil. 2022 Jul;44(15):4090-4095. doi:10.1080/09638288.2021.1891466
Kaya D, Isik AT, Usarel C, Soysal P, Ellidokuz H, Grossberg GT.The Saint Louis University mental status examination is better than the mini-mental state examination to determine the cognitive impairment in Turkish elderly people.J Am Med Dir Assoc. 2016;17(4):370.e11-15. doi:10.1016/j.jamda.2015.12.093
Wu Y, Wang Y, Zhang Y, Yuan X, Gao X.A preliminary study of the Saint Louis University Mental Status examination (SLUMS) for the assessment of cognition in moderate to severe traumatic brain injury patients.Appl Neuropsychol Adult.2023 Jul-Aug;30(4):409-413. doi:10.1080/23279095.2021.1952414
Kueper JK, Speechley M, Montero-Odasso M.The Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog): modifications and responsiveness in pre-dementia populations. a narrative review.J Alzheimers Dis. 2018;63(2):423-444. doi:10.3233/JAD-170991
Stanford Medicine.Short Portable Mental Status Questionnaire (SPMSQ).
Lin JS, O’Connor E, Rossum RC, Perdue LA, Eckstrom E.Screening for cognitive impairment in older adults: a systematic review for the U.S. Preventive Services Task Force.Ann Intern Med. 2013 Nov 5;159(9):601-12. doi:10.7326/0003-4819-159-9-201311050-00730
McCabe D.The Confusion Assessment Method (CAM).Try This Best Practices Nurs Care Older Adults.2019;13;1-2.
Veteran’s Administration.Confusion Assessment Method (CAM).
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