Therefore, comparisons across cutscores and CDR rating to other recently developed dementia screens requiring less time to administer is recommended. The MoCA's range of specificity is wide across the few studies that have examined its clinical utility, and it has not been compared to screens other than the MMSE. 2401), further empirical attention is needed. (2007) recommended the MoCA for use by primary care physicians with “plenty of time available” (p. The MoCA is a promising alternative to the MMSE because of its sensitivity to early detection of dementia and MCI. The number of Parkinson's patients scoring below the cutoff score on the MoCA and MMSE were compared, but not the overall operating characteristics of the two measures.
A caveat does exist, however, for both the previously mentioned studies. (2008) also found that a sample of PD patients performed significantly worse on the MoCA than the MMSE-32% scoring below the cutoff on the MoCA compared to only 11% on the MMSE. (2009) found that 52% of the sample scored below the MoCA's recommended cutoff. In a study of 100 patients diagnosed with PD and scoring in the normal range on the MMSE, Nazem et al. The MoCA has also received empirical attention for its ability to detect cognitive impairment in people with Parkinson's disease. At a cutoff of 26, the MoCA yielded high sensitivity but low specificity, but when a cutscore of 23 was used, both sensitivity and specificity were excellent (0.96 and 0.95, respectively). In a later study by Luis, Keegan, and Mullan, (2009) the recommended cutscore was re-evaluated. These sensitivities were comparable to those of the validation study, but the obtained specificity of 0.50 was significantly lower. Sensitivity of the MoCA and MMSE (using a cutscore of 26) were observed to be 0.83 and 0.17, respectively, for the MCI group and 0.94 and 0.25, respectively, for the AD group. In a study by Smith and colleagues (2007), the utility estimates of the MoCA and MMSE were compared in a sample of 67 elders (32 AD, 23 MCI, and 12 NC). Subsequent studies have demonstrated a trend characterized by high sensitivity and low specificity for the MoCA. The MoCA was influenced by education, prompting the authors to recommend adding one point to the cutscore for elders with over 12 years of education. PPV for the MoCA was 0.89 for both groups and NPV of 0.91 and 1.00 for the MCI and AD groups, respectively. The MoCA outperformed the MMSE across both MCI and AD groups (MoCA sensitivity 0.90 and 1.00, respectively), but its specificity was observed to be lower than that of the MMSE (although still high at 0.87). Both English and French versions were used so the measure could be administered according to language preference. In the original validation study, the MoCA was administered to 277 elders-93 AD, 94 MCI, and 90 NC-recruited from the Jewish General Hospital Memory Clinic in Montreal, Quebec ( Nasreddine et al., 2005). The measure is available in 27 languages along with instructions and normative data at. The MoCA is scored by obtaining an item total and the authors recommend a clinical cutoff score of 26.
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Thirty items assessing multiple cognitive domains are contained in the MoCA: short-term memory (5 points) visuospatial abilities via clock drawing (3 points), and a cube copy task (1 point) executive functioning via an adaptation of Trail Making Test Part B (1 point), phonemic fluency (1 point), and verbal abstraction (2 points) attention, concentration, and working memory via target detection (1 point), serial subtraction (3 points), digits forward (1 point), and digits backward (1 point) language via confrontation naming with low-familiarity animals (3 points), and repetition of complex sentences (2 points) and orientation to time and place (6 points) ( Nasreddine et al., 2005). The Montreal Cognitive Assessment (MoCA Nasreddine et al., 2005) takes approximately 10 minutes to administer and was designed to detect mild cognitive impairment in elders scoring in the normal range on the MMSE. Mast, Adam Gerstenecker, in Handbook of Assessment in Clinical Gerontology (Second Edition), 2010 Montreal Cognitive Assessment (MoCA)
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