Occupational Medicine 2015;65:764–765
doi:10.1093/occmed/kqv078
QUESTIONNAIRE REVIEW
The Montreal Cognitive Assessment (MoCA)
Brief history
The Montreal Cognitive Assessment (MoCA) was devel-
oped by Dr Ziad Nasreddine in Montreal, Canada in 1995
for the detection of mild cognitive impairment (MCI) by
health professionals. MCI is a syndrome defined as cogni-
tive decline greater than expected for an individual’s age
and education level but that does not interfere not­ably
with activities of daily life [1]. The prevalence of MCI in
population-based epidemiological studies ranges from 3
to 19% in adults older than 65 years and more than half
progress to dementia within 5 years. The MoCA may be
useful in the occupational health setting for detecting
MCI or early dementia especially as the workforce ages.
A comprehensive website provides the test, instructions,
normative data, references, frequently asked questions
and permissions and updates [2].
Description
The assessment consists of a 30 point test on a single side
of A4 and can be administered in 10 min. A score of 26
or above is considered normal. MoCA is free for use by
universities, foundations, health professionals, hospitals,
clinics and public health institutes. It is available in over
30 languages. The test may be administered by anyone
who understands and follows the instructions but the
website states that only a health professional with exper-
tise in the cognitive field should interpret the results. In
my opinion and experience, the MoCA is suitable and
very useful as a convenient screening tool for use in the
occupational health clinic by occupational health doctors
and nurses. A less than satisfactory score would suggest
the need for referral to a specialist for further assessment.
Items
The MoCA assesses several cognitive domains. These
are Visuospatial/Executive, Naming, Memory, Attention,
Language, Abstraction, Delayed Recall and Orientation
(to time and place). Many of the elements are familiar or
similar to other tests of cognitive function. Visuospatial
abilities are assessed using a clock-drawing task and a
trail-making task which is said to be useful in assessing
fitness to drive. Attention, concentration and working
memory are evaluated using a sustained attention task
(target detection using tapping), a serial subtraction task
and digits forward and backward.
© The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
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Validity
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The MoCA is validated for use in 55–85 year olds. The
original study was carried out on 90 controls, 94 patients
with MCI and 93 patients with Alzheimer’s Disease [3].
Their average scores were 27.4, 22.1 and 16.2, respect­
ively. The MoCA has been validated in many conditions
including MCI, Alzheimer’s disease and Parkinson’s
Disease dementia [3–5]. The MoCA has been found
to be superior to the Mini-Mental State Examination
(MMSE) as a global assessment tool, particularly in dis-
cerning earlier stages of cognitive decline [6]. A review
comparing different brief assessment tools for cognitive
impairment listed the MoCA’s disadvantages as lacking
studies in general practice settings, an education bias
(12 years), limited use and evidence due to published data
being relatively new (2005) and an administration time
of over 10 min [7]. The MoCA has been recommended
by the National Institutes of Health and the Canadian
Stroke Consortium for detection of vascular cognitive
impairment and the Canadian Consensus Guidelines for
Diagnosis and Treatment of Dementia for detection of
Mild Cognitive Impairment and Alzheimer’s disease [8].
In the UK, the Alzheimer’s Society recommends that the
MoCA should be used for cognitive assessment in mem-
ory clinics and for outpatient specialist assessment [9].
Key research
The website lists over 70 English language references
regarding the use of the MoCA in Alzheimer’s Disease
and MCI. There are also similar lists of references for
its use in a wide range of other conditions including vas-
cular dementia and Parkinson’s Disease. There was no
research found validating the MoCA in an occupational
health setting. The MoCA has been used to assess cogni-
tive decline in manganese workers [10].
John Hobson
email: hon.editor@som.org.uk
References
1. Gauthier S, Reisberg B, Zaudig M et  al. Mild cognitive
impairment. Lancet. 2006;367:1262–1270.
2. http://www.mocatest.org/ (1 December 2014, date last
accessed).
3. Nasreddine ZS, Philllips NA, Bédirian V et  al. The
Montreal Cognitive Assessment (MoCA): a brief

screening tool for mild cognitive impairment. J Am Geriatr
Soc 2005;53:695–699.
4. Smith T, Gildeh N, Holmes C. The Montreal Cognitive
Assessment: validity and utility in a memory clinic setting.
Can J Psychiatry 2007;52:329–332.
5. Dalrymple-Alford JC, MacAskill MR, Nakas CT et  al.
The MoCA: well-suited screen for cognitive impairment in
Parkinson disease. Neurology 2010;75:1717.
6. Roalf D, Moberg PJ, Xie SX, Wolk DA, Moelter ST, Arnold
SE. Comparative accuracies of two common screen-
ing instruments for classification of Alzheimer’s disease,
mild cognitive impairment, and healthy aging. Alzheimers
Dement 2013;9:529–537.
Questionnaire Review  765
7. Cordell C, Borson B, Boustani M et  al. Alzheimer’s
Association recommendations for operationalizing the
detection of cognitive impairment during the Medicare
Annual Wellness Visit in a primary care setting. Alzheimers
Dement 2013;9:141–150.
8. http://en.wikipedia.org/wiki/Montreal_Cognitive_
Assessment (1 December 2014, date last accessed).
9. Helping You to Assess Cognition. A  Practical Toolkit for
Clinicians. Alzheimer’s Society. March 2013. http://www.
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alzheimers.org.uk/ (1 December 2014, date last accessed).
10. Zou Y, Qing L, Zeng X et al. Cognitive function and plasma
BDNF levels among manganese-exposed smelters. Occup
Environ Med 2014;71:189–194.