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The topic of this training session
is Montreal Cognitive Assessment,

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MoCa, Administration and Scoring.

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The objectives are to learn how to
administer the MoCA, and to understand

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the scoring procedures and to interpret
a patient's performance on the tool.

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And also to practice scoring
a sample patient's exam.

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Before we start, it would be helpful if
you have in front of you both a copy of

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the MoCA form as well as the instructions.

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You can download both at
the website shown on the page.

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It's also helpful if you have already
viewed the MoCA video with patient Sam and

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tried to score his MoCA
on your own because we

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will go through that a little bit later.

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This is a screen shot of what
the instrument looks like.

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Before administering the MoCA, you wanna
make sure you have a patient's full

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attention, that you're
speaking clearly and

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in a reasonable enough volume so that
hearing confounds do not become an issue.

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Make sure before you start that you
record the date, the patient's age, and

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level of education at the top of the form
because you'll need that information

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later when it comes to scoring.

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We'll talk a little bit about
administration and scoring of the MoCA.

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The MoCA is one of the most sensitive, but

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also one of the more technical
screening instruments to administer.

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The instructions are very nuanced, and
so it's important to read through them

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carefully before actually trying to
administer the screen with a patient.

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You'll need to know which
items can be repeated, and

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how questions should be phrased, because
this is important for some of the items.

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Again, the MoCA instructions
are very clear and very exacting.

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And therefore, I'm only going to
highlight a few administration issues on

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some of the items.

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Question number one is about trail making.

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That is, the patient has to alternate back
and forth between numbers and letters.

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Note that if a patient self-corrects
an error, and recognizes the error,

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and changes course,
you can give them full credit.

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However, uncorrected mistakes of
any kind are scored zero points.

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Question number three is
a clock drawing task.

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It's important to keep in mind
here that scoring of this clock is

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broken up into three separate components,
each of which is awarded one point.

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Give patients the benefit of the doubt for
the contour or the shape of the circle.

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This is because in clinical experience,
when many patients draw a circle,

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they do so rather hastily.

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Note also that the hour hand must
be shorter than the minute hand.

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On other instruments like the mini cog,
the length of the hands does not matter.

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But for the MoCA, the hand length
is incorporated into scoring.

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For the word list on question number five,
this portion is not scored.

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All you're doing here is just
allowing the patient to register and

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repeat back the words to you.

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After the patient has successfully
repeated the list two times,

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do not forget to say that you will ask for
those same words again a little later.

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Question number six involves digit span.

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Make sure that you say each number
separately as in two, one, eight.

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And say each number
approximately one second apart.

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The administration of question number
seven is a little tricky because you need

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to both fluidly say a string of long
letters, and also, at the same time, keep

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track of when the patient is responding or
tapping to all the letter As.

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Make sure that you're positioning the
patient's hand closely enough to you so

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that you can see their hand in your
peripheral vision while you're reading

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the letters.

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Once you begin reciting the letters,
do not stop.

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Make sure the presentation is
continuous and fluid, without pausing.

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For question number 10,
which is word recall,

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you may not need to do the optional
items on this subtest involving

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cuing when you're giving
the patient reminders.

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Only words spontaneously recalled without
cues are actually scored and given credit.

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And it's only that portion of question
number 10 that contributes to

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the total score.

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The last section of the MoCA question
11 is regarding orientation.

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All responses here must
be exact to get credit.

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For example, if a patient does one or
two days off on the date or

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day of the week,
those responses would receive zero points.

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At the end of administration,
add up all the items carefully,

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double check your addition,
make sure that you add one extra point for

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patients with a high school education or
less.

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This is how this instruments accounts for

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educational differences that
can impact performance.

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This is something that can
be easily overlooked and

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can make the difference between
a passing or a failing score.

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So try to remember that educational
component at the very end.

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A passing score on the instrument
is a score of 26 or higher.

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The MoCA is scored out
of a possible 30 points.

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A failure is a score of 25 or less.

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Hopefully, you have already seen
the patient Sam completing the MoCA,

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and tried to score his
performance yourself.

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We will now review his performance and
score the instrument together.

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For the first couple of items,
Sam performed them correctly.

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He was able to do the alternating back and
forth between numbers and

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letters appropriately, and
also did reasonably well on the cube copy.

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This is a screenshot of Sam's clock.

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Note that, like many patients, Sam was a
little bit hasty in drawing the circle and

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did not fully close the circle at the top.

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I, in this case, would give Sam
the benefit of the doubt for generally

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creating the circle appropriately,
and award one point for contour.

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Sam also has all the numbers in their
correct location with no duplicate

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numbers, so he receives another point for
the number scoring.

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With regard to the hands, you'll note
that instead of placing the hands

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at 10 past 11, Sam has drawn one
hand to the 10 and one to the 11.

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This is a more concrete performance,
and for

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that section would receive zero points.

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That means that Sam's total points for the
clock draw are two out of three points.

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For animal naming, Sam was able to name
correctly all of the animals shown on

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the page, so he gets full credit for that.

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He was also able to appropriately repeat
the list of five words on both trials.

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For the first component of the attention
subtest where Sam was repeating numbers,

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he successfully completed both
of those correctly, and so

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also receives full credit,
two out of two points.

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During the hand tapping portion,
Sam made several mistakes along

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the way in response to As that
were said by the examiner.

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Because he made two or more errors,
he received zero points for

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this portion of the test.

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The next question was about serial sevens.

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You'll notice that Sam got some of
these correct, but others wrong.

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Therefore, he was able to correctly
subtract seven two times,

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which corresponds to a score
of two out of three.

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And you can see underneath the numbers

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there are instructions about
how to score this section.

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Under language, Sam was able to
repeat both sentences correctly, so

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receives two out of two points.

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When he was asked to name words in one
minute that begin with the letter F,

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he was able to name more than eleven, and
so receives a full credit, one point.

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And for abstraction, for the first item,

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train and bicycle,
Sam struggled a little bit.

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His answer related to wheels that
operate in the same way or have elbows.

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And that's considered
a more concrete response.

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The MoCA instructions detail out
a little bit more specifically

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what is a good response or a bad response.

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For that item, the train and bicycle,
Sam did not not receive full credit.

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But he did answer appropriately when asked
about the similarity between a watch

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and a ruler.

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So he receives one out of a total
two points in that direction.

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When Sam was asked to remember the words
that were given to him earlier,

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unfortunately he was not able to
remember any of the words, and so

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received zero points.

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For the last section orientation,
Sam was able to answer all of those

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questions correctly, and
so received six points.

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When all of the sub components
are added together,

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Sam's total score on
the MoCA is 21 over 30.

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Adding an extra point is not
necessary because Sam has more than

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a high school education, so
his total score is 21 points.

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The ACT on Alzheimer's website has
many provider tools that simplify

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the screening process, and
also provide simple instructions for

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what to do when patients pass and
fail the screen.

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For more information to
download these free tools,

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please visit the ACT on Alzheimer's
website at the link provided,

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or you can also contact ACT
on Alzheimer's staff using

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the information on the slide below.