MoCA and Cognitive
Screenings Simplified
The Montreal Cognitive
Assessment [MoCA] is a scripted assessment in which the professional administrator
reads word for word to ensure accuracy. It is administered by physicians,
clinicians, and aging experts as part of an overall assessment of
mental/cognitive functioning. There are many other reliable screening tools
including the MMSE, GPCog, SLUMS, Mini-Cog, AAFP, Animal Naming, MIS, AD8, and
online screenings available from the Alzheimer’s Foundation of America. When I
assess older adults for cognitive functioning, I use two of these tools. Often,
the examination serves as a baseline, as none of them are used for diagnostic
purposes.
The MoCA has high
reliability or at least it did until recently. The media has featured
interviews of President Trump bragging about acing it and some of his comments
are
misleading. From the
instructions, #5 Memory: “Administration: The examiner reads a list of 5 words
at a rate of one per second, giving the following instructions: This is a
memory test. I am going to read a list of words that you will have to remember
now and later on. Listen carefully. When I am through, tell me as many words as
you can remember. It
doesn’t matter in what order you say them”. I have highlighted this section, as it is directly from the script.
At the end of the
assessment, one point is allocated for each word recalled freely. There are NO
EXTRA POINTS for naming them in the order given.
The MoCA does NOT measure IQ
or intelligence. According to Dr. Ziad
Nassreddine, creator of the instrument, the MoCA is a straightforward tool with
the ability to assess several cognitive domains. The MoCA test is a proven and
useful cognitive screening tool for many illnesses, including:
Alzheimer’s disease
Parkinson’s disease
Huntington’s disease
Lewy Body
VCI/Stroke
Fronto-temporal dementia
Brain metastasis
ALS
Sleep behavior disorder
Brain tumors
Multiple sclerosis
Head trauma
Depression
Schizophrenia
Heart failure
Substance abuse
HIV
And more”
In an interview today, Dr. Nasreddine
explained that each question is related to a different part of the brain
[domains]. He declined to share a sample test page, as he and his peers are
growing increasingly concerned that the test might not be as accurate anymore,
because too many elements have been shared online. This allows people to
potentially practice the questions to perform better on the exam. He added, “The
purpose is to detect impairment; it’s not meant to determine if someone has
extremely high levels of abilities.”
Dementia researcher Dr.
Jason Karlawish, of the University of Pennsylvania Perelman School of Medicine,
told the New York Times, “You would think he [Trump] would understand clearly
what the test result was and why the test was done,” Dr. Karlawish said, “and
not turn it into a competition about mental health.”
I have included resources
below for learning more about cognitive testing and how they are used in the assessment
of functioning.
Wikipedia also has a summary
in easily understood language: https://en.wikipedia.org/wiki/Montreal_Cognitive_Assessment
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