The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment

TLDR

Mild cognitive impairment is a developing and debated clinical entity. The study aimed to create a 10‑minute Montreal Cognitive Assessment (MoCA) to help clinicians detect mild cognitive impairment. The authors validated the MoCA in 94 MCI patients, 93 mild AD patients, and 90 healthy controls, comparing it to the MMSE across community and academic settings. With a cutoff of 26, the MoCA identified 90 % of MCI cases and 100 % of mild AD cases, far outperforming the MMSE (18 % and 78 % sensitivity, respectively) while maintaining high specificity.

Abstract

To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. Validation study. A community clinic and an academic center. Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.