The Montreal Cognitive Assessment (MoCA) For Dementia & Mild Cognitive Impairment

Dementia and Alzheimer’s are increasingly prevalent and damaging in our modern society. We have a growing elderly population with a higher life expectancy. Among this group, many will develop some form of cognitive disability, dementia or Alzheimer’s disease itself.

There is a strong desire to detect these diseases as soon as possible in order to provide the best treatment and outlook for a patient. Dementia patients can have a better quality of life if the illness is managed from an earlier age. This is why it is so important that health care providers offer the very best testing solutions. One such option is the MoCA – the Montreal Cognitive Assessment.

The MoCA is a popular testing procedure among a series of similar screening options. The test is designed a “brief cognitive screening tool for Mild Cognitive Impairment”. At least, that is the aim according to the official website. It is arguable that this description does do justice to the potential of the test. This test has helped doctors detect signs of cognitive illness, brain injury and conditions like dementia and Alzheimer’s. So, what exactly is this test, why would patients take it and why is it so highly regarded as a diagnostic tool?

The MoCA can act as a helpful screening tool for patients with cognitive issues.

There are some people that will exhibit signs of dementia with no obvious alternative cause. It is important to separate clear signs of dementia or Alzheimer’s from side effects of illness or “senior moments”. There are times when we all struggle to remember simple things – where we parked the car, what day of the week it is, the name of a vague acquaintance. These moments don’t necessarily mean that a senior has dementia. At the same time, illnesses such as urinary tract infections can produce dementia-like symptoms, confusion and distress. If doctors cannot find a root cause for current cognitive impairment, or it is too severe to be a “senior moment”, it might be worthwhile to try the MoCA

This test has been in the news a little more in recent years. After it was revealed that President Trump took the test – with a final score of 30 out of 30 – others felt the need to try the test for themselves.

What Cognitive Skills Does MoCA Test?

The main aim of the MoCA is to look at cognitive function in a number of different areas. These include:

  1. Memory
  2. Awareness
  3. Orientation
  4. Language
  5. Abstract reasoning
  6. Concentration
  7. Attention


This means memory both in terms of working memory and short-term recall. Memory loss, especially short-term recall issues, are common with those developing dementia and Alzheimer’s. Delayed recall is an important tool here. Test subjects are given a list of words to recall and repeat. They are also expected to be able to recall them on demand following other tests. This determines the function of different levels of short-term memory.


This relates to a sense of awareness about spacial awareness, as well as aspects of time and place. The test refers to the latter as orientation. The subject will be asked to state the date, month and year, as well as where they are, including the city they are in. This is important because while a patient may same sharp and able with other cognitive tests, they may be disorientated in regard to time and place. They may be adamant that it is March or that they are in the city in which they formally resided. As for visuospatial ability, one test involved drawing a line through the correct path of letter and numbers.


Then there are other cognitive areas around attention and concentration. Part of this includes the ability to follow a pattern offered up by the doctor. This could be as simple as counting up to 10 and back down to 1. This determines whether they can hold their focus on the task at hand.

Language Skills and Abstraction:

Language skills are important when dealing with cognitive impairments. This means a simple test of sentence recall, the ability to create lists based around a certain letter of the alphabet and basic naming exercises. Abstraction is a little different. Here patients use language to explain how items are alike. This tests abstract reasoning.

The Clock Drawing Test:

This new addition is an important tool used in a range of dementia tests. The idea is that test subjects have to draw a clock face, with the numbers in the right place, and then draw the hands at a particular time. In many cases, dementia sufferers can’t accurately create this layout. However, the same is true for people with brain injury and other impairments. Therefore, failure here isn’t definite proof of dementia.

The Procedure and Scoring System

This test is designed to be simple enough to use on any senior exhibiting symptoms of dementia and Alzheimer’s. There is just one page of questions that covers 30 different points. It is the same for all seniors, regardless of the reason for their referral. It should take no longer than 10 minutes and can be administered by any doctor in general practice.

In the end, there are 5 possible points for visuospatial and executive functioning, 3 points for animal naming, 6 points for attention and concentration, 3 points for language, 2 points for abstraction, 6 for orientation, 5 for short-term memory and an extra point for education level. The total points are tallied into a final score. A score of 26 and above is normal with no cause for alarm. People with mild cognitive impairment average out at 22.1 and those with Alzheimer’s average at 16.2.

So What are the Benefits and Disadvantages of MoCA?

There are benefits to this simple, inclusive approach to the test. One of the most important benefits here is accessibility for patients. This system is a quick, hassle-free approach that won’t prove to be too distressing to anyone that is dealing with severe cognitive issues and Alzheimer’s. This doctor-led test is also reassuring for carers as they can be sure of a reliable result and accurate scoring.

Another benefit of this testing option is that it is universal in its accessibility. There are versions for the blind and visually impaired. There is also the chance to take the test in over 35 languages. This means that immigrants can take the test in a native tongue if this is more comfortable for them.

There are also some downsides to this sort of approach. A short, 30 point test covers the basics and is designed to help as many people in as broad a sense as possible. This means that there is a chance that some doctors may miss signs as they follow this strict model. Also, doctors performing the test don’t require any special training.

The upside here is that a friendly, family general practice doctor can help. The downside is that they may not be up to date with information on Alzheimer’s and other cognitive issues. This highlights the ease-of-use of the test. But, it does mean that doctors may not be able to provide further help in difficult cases. If a patient shows enough red flags, they will need to be referred again. This broader approach also means that there is no way of distinguishing between forms of dementia without this further analysis. A bad result doesn’t mean a 100% likelihood of an Alzheimer’s diagnosis. Yet, this notion is sure to cross the mind of many relatives.

Is MoCA Test Better Than MMSE?

Some carers in this situation may be familiar with the MMSE test, this is the Mini Mental Status Exam (like this one). The MMSE is more commonly used to assess patients for symptoms of Alzheimer’s. However, many would argue that it is not the best choice. The MMSE deals primarily with memory recall. Any relative that deals with Alzheimer’s patient on a regular basis can attest that memory issues are just a small part of the disease.

The wider questioning on the MoCA is preferable for diagnosing Alzheimer’s. The detail of this exam also means that doctors are better able to detect early-onset disease and mild impairments. This early diagnosis can be crucial when determining the best treatment plan and a better quality of life for the patient.

How Does MoCA Compare to the Mini-Cog?

The mini-cog is an even faster diagnostic tool used by doctors on people with dementia symptoms. There is a high level of accuracy here and it is quick and painless for the subject. It uses recall testing and the clock-drawing test, but little else. This means that it is only helpful to a point. It is a great tool in cases where Alzheimer’s is strongly suspected. But, it may not prove as helpful as the MoCA for discovering other cognitive issues.

Can You Take MoCA Test Online?

As was mentioned above, public interest in the MoCA grew following the report about President Trump’s perfect score. This publicity leads to the idea of creating an online version of the MoCA that anyone can use at home. The idea is that this “scaled down” tool will provide a taste of the real test for those interesting in their own score. A visit to the official MoCA also shows that there is an electronic version in progress.

This electronic version of the test could be a great help to anyone that is housebound or those that feel that an at-home test would be more accommodating for the subject. The problem is that some relatives may try and ask the question themselves. This may lead to some form of bias in the questioning or a misinterpretation of the answers. This sort of testing needs a reliable, objective approach from a medical professional.

The concept of shorter, at-home versions of this test is appealing. Where possible, we want to ensure that our family members are calm, secure and face minimal disruption. However, we also need to ensure that tests are conducted by neutral, objective doctors.

If you have a relative that is exhibiting signs of dementia or Alzheimer’s, the best approach is to talk to a doctor. They can rule out other medical causes and perform the MoCA in a professional manner. They can also help with referrals and support. Remember that these tests are an important step in a longer process. Don’t rush this step or skip other important ones out of fear other the diagnosis.

What Happens After You Take the Test?

After this 30 point test, a patient’s doctor will have a better idea of their cognitive state. Those that don’t score well will need to undergo further testing to determine the reason for the results. For some, this will mean a diagnosis of Alzheimer’s.

Early detection and a better understanding of the symptoms can result in a clear, effective treatment plan. Others may be dealing with a different form of dementia and/or other conditions. For example, there is a form of dementia linked to Parkinson’s disease. Further analysis can either detect or rule out this threat. In addition to this, the MoCA has been a helpful tool in the detection of other issues, such as Huntington’s disease, brain injury, tumors and even MS.

Once you have a diagnosis, or suspected cause, you can work on the best possible treatment plan. The data from the MoCA and additional testing should give a good indication of cognitive function and the severity of the disease.

The MoCA is one of the best tools around for diagnosing dementia and Alzheimer’s. If you are interested to know more about this debilitating disease you should take a look at our extensive article about Alzheimer’s disease and read about 7 Stages of Alzheimer’s disease in this article here.

This test may have been designed as a means of determining mild cognitive impairment, but it actually has a much broader reach. The MoCA has surpassed other testing options in the way that it looks at cognitive impairment. The addition of the clock test and the focus on recall, orientation and abstraction show a better understanding of cognitive issues. It isn’t always enough to rely on a quick mini-cog test or anything purely for dementia. The accuracy and results from these tests strengthen this idea that the MoCA really is the best choice for seniors with dementia symptoms. Take advantage of this tool where applicable and see how it can help your loved one.