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I now have comprehensive information. You likely meant the Montreal Cognitive Assessment (MoCA), commonly called the "Montreal sign/test" in clinical shorthand. Here is a full overview:
Montreal Cognitive Assessment (MoCA)
The Montreal Cognitive Assessment (MoCA) is a brief, standardized 30-point cognitive screening tool developed by Dr. Ziad Nasreddine in 1995 (published 2005) to detect mild cognitive impairment (MCI) and early dementia in clinical settings.
Key Features
| Feature | Detail |
|---|---|
| Total score | 30 points |
| Administration time | ~10 minutes |
| Normal cutoff | ≥ 26/30 (original); education-adjusted norms now preferred |
| Education adjustment | +1 point if ≤ 12 years of formal education |
| Languages available | 30+ languages and dialects |
Domains Tested (7 domains)
- Visuospatial/Executive (5 pts) - Trail-making (alternating numbers/letters), cube copy, clock drawing (time: ten past eleven)
- Naming (3 pts) - Identify drawings of a lion, rhinoceros, and camel
- Memory (no immediate points) - Read 5 words (FACE, VELVET, CHURCH, DAISY, RED); two learning trials; delayed recall tested later
- Attention (6 pts) - Forward and backward digit span, letter tapping (tap at letter "A"), serial 7 subtractions from 100
- Language (3 pts) - Sentence repetition x2, verbal fluency (words beginning with "F" in 1 minute, ≥11 = 1 pt)
- Abstraction (2 pts) - Similarities (train-bicycle, watch-ruler)
- Delayed Recall (5 pts) - Free recall of 5 words after 5 minutes; optional category/multiple choice cues (no points for cued recall)
- Orientation (6 pts) - Date, month, year, day, place, city
Scoring Interpretation
- 26-30: Normal
- 18-25: Mild cognitive impairment (MCI)
- 10-17: Moderate impairment
- < 10: Severe impairment
Scores are influenced by age and education, so population-adjusted normative tables (Table 44.5 in Bradley & Daroff) should be used rather than a single universal cutoff.
Clinical Uses
The MoCA has been validated as a sensitive screener in:
- Alzheimer disease and other dementias
- Vascular dementia after acute stroke
- Parkinson disease (more sensitive than MMSE for executive/frontal dysfunction)
- Huntington disease
- Post-stroke cognitive impairment
- Brain metastases
It is more sensitive than the MMSE for detecting executive dysfunction (frontal lobe) and MCI, because it includes harder tasks (trail-making, abstraction, serial 7s).
MoCA vs. MMSE
| Feature | MoCA | MMSE |
|---|---|---|
| Executive function | Yes (Trail-making, abstraction) | Minimal |
| Sensitivity for MCI | Higher (~94% for dementia) | Lower |
| False positives | ~40% of healthy individuals score <26 | Less |
| Cost | Free (mocatest.org) | Now copyrighted/fee |
| Difficulty | More difficult | Easier |
Important Caveats
- The MoCA should not be used as a standalone diagnostic tool. It is a screening instrument to flag the need for formal neuropsychological testing.
- Reliability is lower in non-clinical (healthy) populations - it should primarily be used in patients with suspected cognitive impairment.
- The original cut score of 26 was developed without fully accounting for age, education, or cultural variables.
- As per the U.S. Affordable Care Act (2010), an annual cognitive assessment is suggested for all Medicare patients.
Sources:
- Bradley and Daroff's Neurology in Clinical Practice, p. 893-895 (Section: Montreal Cognitive Assessment)
- Nasreddine et al., J Am Geriatr Soc. 2005;53:695-699 (original validation paper)
- mocatest.org - official resource with all language versions
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