The MoCA test is a one-page 30-point test administered in approximately 10 minutes. The test and administration instructions are available for clinicians online. The test is available in 46 languages and dialects. The MoCA assesses several cognitive domains:
The short-term memory recall task involves two learning trials of five nouns and delayed recall after approximately five minutes.
Visuospatial abilities are assessed using a clock-drawing task and a three-dimensional cube copy.
Multiple aspects of executive functions are assessed using an alternation task adapted from the trail-making B task, a phonemic fluency task, and a two-item verbal abstraction task.
Language is assessed using a three-item confrontation naming task with low-familiarity animals, repetition of two syntactically complex sentences, and the aforementioned fluency task.
Abstract reasoning is assessed using a describe the similarity task with 2 points being available.
Finally, orientation to time and place is evaluated by asking the subject for the date and the city in which the test is occurring.
Because MoCA is English specific, linguistic and cultural translations are made in order to adapt the test in other countries. Multiple cultural and linguistic variables may affect the norms of the MoCA across different countries and languages e.g. Swedish. Several cut-off scores have been suggested across different languages to compensate for education level of the population, and several modifications were also necessary to accommodate certain linguistic and cultural differences across different languages/countries. However, not all versions have been validated.
Efficacy
MoCA test study
A MoCA test validation study by Nasreddine in 2005 showed that the MoCA was a promising tool for detecting Mild Cognitive Impairment and Early Alzheimer's disease compared with the well-known Mini-Mental State Examination. According to the validation study, the sensitivity and specificity of the MoCA for detecting MCI were 90% and 87% respectively, compared with 18% and 100% respectively for the MMSE. Subsequent studies in other settings were less promising, though generally superior to the MMSE. Other studies have tested the MoCA on patients with Alzheimer's disease.
MoCA scores range between 0 and 30. A score of 26 or over is considered to be normal. In a study, people without cognitive impairment scored an average of 27.4; people with mild cognitive impairment scored an average of 22.1; people with Alzheimer's disease scored an average of 16.2. In a study by Ihle-Hansen et al., of 3,413 Norwegian participants aged 63-65, of whom 47% had higher education, under 5% of subjects scored 30/30 with a mean MoCA score of 25.3 and 49% scoring below the suggested cut-off of 26 points, leading the authors to suggest that "the cut-off score may have been set too high to distinguish normal cognitive function from MCI".
