[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.00,0:00:04.80,Default,,0000,0000,0000,,The topic of this training session\Nis Montreal Cognitive Assessment,
Dialogue: 0,0:00:04.80,0:00:07.37,Default,,0000,0000,0000,,MoCa, Administration and Scoring.
Dialogue: 0,0:00:07.37,0:00:11.60,Default,,0000,0000,0000,,The objectives are to learn how to\Nadminister the MoCA, and to understand
Dialogue: 0,0:00:11.60,0:00:16.20,Default,,0000,0000,0000,,the scoring procedures and to interpret\Na patient's performance on the tool.
Dialogue: 0,0:00:16.20,0:00:20.23,Default,,0000,0000,0000,,And also to practice scoring\Na sample patient's exam.
Dialogue: 0,0:00:20.23,0:00:24.92,Default,,0000,0000,0000,,Before we start, it would be helpful if\Nyou have in front of you both a copy of
Dialogue: 0,0:00:24.92,0:00:27.61,Default,,0000,0000,0000,,the MoCA form as well as the instructions.
Dialogue: 0,0:00:27.61,0:00:31.24,Default,,0000,0000,0000,,You can download both at\Nthe website shown on the page.
Dialogue: 0,0:00:31.24,0:00:37.20,Default,,0000,0000,0000,,It's also helpful if you have already\Nviewed the MoCA video with patient Sam and
Dialogue: 0,0:00:37.20,0:00:40.49,Default,,0000,0000,0000,,tried to score his MoCA\Non your own because we
Dialogue: 0,0:00:40.49,0:00:43.53,Default,,0000,0000,0000,,will go through that a little bit later.
Dialogue: 0,0:00:43.53,0:00:46.61,Default,,0000,0000,0000,,This is a screen shot of what\Nthe instrument looks like.
Dialogue: 0,0:00:49.24,0:00:53.45,Default,,0000,0000,0000,,Before administering the MoCA, you wanna\Nmake sure you have a patient's full
Dialogue: 0,0:00:53.45,0:00:56.00,Default,,0000,0000,0000,,attention, that you're\Nspeaking clearly and
Dialogue: 0,0:00:56.00,0:01:00.29,Default,,0000,0000,0000,,in a reasonable enough volume so that\Nhearing confounds do not become an issue.
Dialogue: 0,0:01:00.29,0:01:04.95,Default,,0000,0000,0000,,Make sure before you start that you\Nrecord the date, the patient's age, and
Dialogue: 0,0:01:04.95,0:01:09.67,Default,,0000,0000,0000,,level of education at the top of the form\Nbecause you'll need that information
Dialogue: 0,0:01:09.67,0:01:11.62,Default,,0000,0000,0000,,later when it comes to scoring.
Dialogue: 0,0:01:11.62,0:01:15.26,Default,,0000,0000,0000,,We'll talk a little bit about\Nadministration and scoring of the MoCA.
Dialogue: 0,0:01:15.26,0:01:18.08,Default,,0000,0000,0000,,The MoCA is one of the most sensitive, but
Dialogue: 0,0:01:18.08,0:01:22.84,Default,,0000,0000,0000,,also one of the more technical\Nscreening instruments to administer.
Dialogue: 0,0:01:22.84,0:01:27.27,Default,,0000,0000,0000,,The instructions are very nuanced, and\Nso it's important to read through them
Dialogue: 0,0:01:27.27,0:01:31.52,Default,,0000,0000,0000,,carefully before actually trying to\Nadminister the screen with a patient.
Dialogue: 0,0:01:31.52,0:01:34.54,Default,,0000,0000,0000,,You'll need to know which\Nitems can be repeated, and
Dialogue: 0,0:01:34.54,0:01:39.27,Default,,0000,0000,0000,,how questions should be phrased, because\Nthis is important for some of the items.
Dialogue: 0,0:01:39.27,0:01:43.40,Default,,0000,0000,0000,,Again, the MoCA instructions\Nare very clear and very exacting.
Dialogue: 0,0:01:43.40,0:01:48.25,Default,,0000,0000,0000,,And therefore, I'm only going to\Nhighlight a few administration issues on
Dialogue: 0,0:01:48.25,0:01:49.46,Default,,0000,0000,0000,,some of the items.
Dialogue: 0,0:01:49.46,0:01:52.33,Default,,0000,0000,0000,,Question number one is about trail making.
Dialogue: 0,0:01:52.33,0:01:57.69,Default,,0000,0000,0000,,That is, the patient has to alternate back\Nand forth between numbers and letters.
Dialogue: 0,0:01:57.69,0:02:02.86,Default,,0000,0000,0000,,Note that if a patient self-corrects\Nan error, and recognizes the error,
Dialogue: 0,0:02:02.86,0:02:06.43,Default,,0000,0000,0000,,and changes course,\Nyou can give them full credit.
Dialogue: 0,0:02:06.43,0:02:11.21,Default,,0000,0000,0000,,However, uncorrected mistakes of\Nany kind are scored zero points.
Dialogue: 0,0:02:13.44,0:02:14.61,Default,,0000,0000,0000,,Question number three is\Na clock drawing task.
Dialogue: 0,0:02:14.61,0:02:19.84,Default,,0000,0000,0000,,It's important to keep in mind\Nhere that scoring of this clock is
Dialogue: 0,0:02:19.84,0:02:26.36,Default,,0000,0000,0000,,broken up into three separate components,\Neach of which is awarded one point.
Dialogue: 0,0:02:26.36,0:02:31.29,Default,,0000,0000,0000,,Give patients the benefit of the doubt for\Nthe contour or the shape of the circle.
Dialogue: 0,0:02:31.29,0:02:36.26,Default,,0000,0000,0000,,This is because in clinical experience,\Nwhen many patients draw a circle,
Dialogue: 0,0:02:36.26,0:02:38.06,Default,,0000,0000,0000,,they do so rather hastily.
Dialogue: 0,0:02:38.06,0:02:43.38,Default,,0000,0000,0000,,Note also that the hour hand must\Nbe shorter than the minute hand.
Dialogue: 0,0:02:43.38,0:02:47.70,Default,,0000,0000,0000,,On other instruments like the mini cog,\Nthe length of the hands does not matter.
Dialogue: 0,0:02:47.70,0:02:52.23,Default,,0000,0000,0000,,But for the MoCA, the hand length\Nis incorporated into scoring.
Dialogue: 0,0:02:52.23,0:02:55.77,Default,,0000,0000,0000,,For the word list on question number five,\Nthis portion is not scored.
Dialogue: 0,0:02:55.77,0:03:00.46,Default,,0000,0000,0000,,All you're doing here is just\Nallowing the patient to register and
Dialogue: 0,0:03:00.46,0:03:02.56,Default,,0000,0000,0000,,repeat back the words to you.
Dialogue: 0,0:03:02.56,0:03:07.40,Default,,0000,0000,0000,,After the patient has successfully\Nrepeated the list two times,
Dialogue: 0,0:03:07.40,0:03:13.21,Default,,0000,0000,0000,,do not forget to say that you will ask for\Nthose same words again a little later.
Dialogue: 0,0:03:13.21,0:03:15.99,Default,,0000,0000,0000,,Question number six involves digit span.
Dialogue: 0,0:03:15.99,0:03:21.43,Default,,0000,0000,0000,,Make sure that you say each number\Nseparately as in two, one, eight.
Dialogue: 0,0:03:21.43,0:03:26.43,Default,,0000,0000,0000,,And say each number\Napproximately one second apart.
Dialogue: 0,0:03:26.43,0:03:30.45,Default,,0000,0000,0000,,The administration of question number\Nseven is a little tricky because you need
Dialogue: 0,0:03:30.45,0:03:34.41,Default,,0000,0000,0000,,to both fluidly say a string of long\Nletters, and also, at the same time, keep
Dialogue: 0,0:03:34.41,0:03:38.02,Default,,0000,0000,0000,,track of when the patient is responding or\Ntapping to all the letter As.
Dialogue: 0,0:03:38.02,0:03:42.94,Default,,0000,0000,0000,,Make sure that you're positioning the\Npatient's hand closely enough to you so
Dialogue: 0,0:03:42.94,0:03:47.57,Default,,0000,0000,0000,,that you can see their hand in your\Nperipheral vision while you're reading
Dialogue: 0,0:03:47.57,0:03:48.46,Default,,0000,0000,0000,,the letters.
Dialogue: 0,0:03:48.46,0:03:51.48,Default,,0000,0000,0000,,Once you begin reciting the letters,\Ndo not stop.
Dialogue: 0,0:03:51.48,0:03:58.29,Default,,0000,0000,0000,,Make sure the presentation is\Ncontinuous and fluid, without pausing.
Dialogue: 0,0:03:58.29,0:04:01.86,Default,,0000,0000,0000,,For question number 10,\Nwhich is word recall,
Dialogue: 0,0:04:01.86,0:04:06.54,Default,,0000,0000,0000,,you may not need to do the optional\Nitems on this subtest involving
Dialogue: 0,0:04:06.54,0:04:10.21,Default,,0000,0000,0000,,cuing when you're giving\Nthe patient reminders.
Dialogue: 0,0:04:10.21,0:04:15.91,Default,,0000,0000,0000,,Only words spontaneously recalled without\Ncues are actually scored and given credit.
Dialogue: 0,0:04:15.91,0:04:20.52,Default,,0000,0000,0000,,And it's only that portion of question\Nnumber 10 that contributes to
Dialogue: 0,0:04:20.52,0:04:21.67,Default,,0000,0000,0000,,the total score.
Dialogue: 0,0:04:21.67,0:04:26.63,Default,,0000,0000,0000,,The last section of the MoCA question\N11 is regarding orientation.
Dialogue: 0,0:04:26.63,0:04:29.63,Default,,0000,0000,0000,,All responses here must\Nbe exact to get credit.
Dialogue: 0,0:04:29.63,0:04:34.02,Default,,0000,0000,0000,,For example, if a patient does one or\Ntwo days off on the date or
Dialogue: 0,0:04:34.02,0:04:38.42,Default,,0000,0000,0000,,day of the week,\Nthose responses would receive zero points.
Dialogue: 0,0:04:38.42,0:04:42.19,Default,,0000,0000,0000,,At the end of administration,\Nadd up all the items carefully,
Dialogue: 0,0:04:42.19,0:04:46.40,Default,,0000,0000,0000,,double check your addition,\Nmake sure that you add one extra point for
Dialogue: 0,0:04:46.40,0:04:49.27,Default,,0000,0000,0000,,patients with a high school education or\Nless.
Dialogue: 0,0:04:49.27,0:04:52.06,Default,,0000,0000,0000,,This is how this instruments accounts for
Dialogue: 0,0:04:52.06,0:04:55.90,Default,,0000,0000,0000,,educational differences that\Ncan impact performance.
Dialogue: 0,0:04:55.90,0:04:58.98,Default,,0000,0000,0000,,This is something that can\Nbe easily overlooked and
Dialogue: 0,0:04:58.98,0:05:02.70,Default,,0000,0000,0000,,can make the difference between\Na passing or a failing score.
Dialogue: 0,0:05:02.70,0:05:06.28,Default,,0000,0000,0000,,So try to remember that educational\Ncomponent at the very end.
Dialogue: 0,0:05:07.40,0:05:13.01,Default,,0000,0000,0000,,A passing score on the instrument\Nis a score of 26 or higher.
Dialogue: 0,0:05:13.01,0:05:16.04,Default,,0000,0000,0000,,The MoCA is scored out\Nof a possible 30 points.
Dialogue: 0,0:05:16.04,0:05:20.72,Default,,0000,0000,0000,,A failure is a score of 25 or less.
Dialogue: 0,0:05:20.72,0:05:25.98,Default,,0000,0000,0000,,Hopefully, you have already seen\Nthe patient Sam completing the MoCA,
Dialogue: 0,0:05:25.98,0:05:29.35,Default,,0000,0000,0000,,and tried to score his\Nperformance yourself.
Dialogue: 0,0:05:29.35,0:05:34.13,Default,,0000,0000,0000,,We will now review his performance and\Nscore the instrument together.
Dialogue: 0,0:05:34.13,0:05:38.04,Default,,0000,0000,0000,,For the first couple of items,\NSam performed them correctly.
Dialogue: 0,0:05:38.04,0:05:41.96,Default,,0000,0000,0000,,He was able to do the alternating back and\Nforth between numbers and
Dialogue: 0,0:05:41.96,0:05:46.24,Default,,0000,0000,0000,,letters appropriately, and\Nalso did reasonably well on the cube copy.
Dialogue: 0,0:05:46.24,0:05:49.11,Default,,0000,0000,0000,,This is a screenshot of Sam's clock.
Dialogue: 0,0:05:49.11,0:05:54.58,Default,,0000,0000,0000,,Note that, like many patients, Sam was a\Nlittle bit hasty in drawing the circle and
Dialogue: 0,0:05:54.58,0:05:57.33,Default,,0000,0000,0000,,did not fully close the circle at the top.
Dialogue: 0,0:05:57.33,0:06:01.49,Default,,0000,0000,0000,,I, in this case, would give Sam\Nthe benefit of the doubt for generally
Dialogue: 0,0:06:01.49,0:06:05.72,Default,,0000,0000,0000,,creating the circle appropriately,\Nand award one point for contour.
Dialogue: 0,0:06:05.72,0:06:10.52,Default,,0000,0000,0000,,Sam also has all the numbers in their\Ncorrect location with no duplicate
Dialogue: 0,0:06:10.52,0:06:14.86,Default,,0000,0000,0000,,numbers, so he receives another point for\Nthe number scoring.
Dialogue: 0,0:06:14.86,0:06:19.85,Default,,0000,0000,0000,,With regard to the hands, you'll note\Nthat instead of placing the hands
Dialogue: 0,0:06:19.85,0:06:24.77,Default,,0000,0000,0000,,at 10 past 11, Sam has drawn one\Nhand to the 10 and one to the 11.
Dialogue: 0,0:06:24.77,0:06:27.57,Default,,0000,0000,0000,,This is a more concrete performance,\Nand for
Dialogue: 0,0:06:27.57,0:06:30.16,Default,,0000,0000,0000,,that section would receive zero points.
Dialogue: 0,0:06:30.16,0:06:37.36,Default,,0000,0000,0000,,That means that Sam's total points for the\Nclock draw are two out of three points.
Dialogue: 0,0:06:37.36,0:06:41.76,Default,,0000,0000,0000,,For animal naming, Sam was able to name\Ncorrectly all of the animals shown on
Dialogue: 0,0:06:41.76,0:06:44.63,Default,,0000,0000,0000,,the page, so he gets full credit for that.
Dialogue: 0,0:06:44.63,0:06:51.11,Default,,0000,0000,0000,,He was also able to appropriately repeat\Nthe list of five words on both trials.
Dialogue: 0,0:06:51.11,0:06:57.28,Default,,0000,0000,0000,,For the first component of the attention\Nsubtest where Sam was repeating numbers,
Dialogue: 0,0:06:57.28,0:07:01.69,Default,,0000,0000,0000,,he successfully completed both\Nof those correctly, and so
Dialogue: 0,0:07:01.69,0:07:05.50,Default,,0000,0000,0000,,also receives full credit,\Ntwo out of two points.
Dialogue: 0,0:07:05.50,0:07:10.10,Default,,0000,0000,0000,,During the hand tapping portion,\NSam made several mistakes along
Dialogue: 0,0:07:10.10,0:07:13.97,Default,,0000,0000,0000,,the way in response to As that\Nwere said by the examiner.
Dialogue: 0,0:07:13.97,0:07:18.44,Default,,0000,0000,0000,,Because he made two or more errors,\Nhe received zero points for
Dialogue: 0,0:07:18.44,0:07:20.31,Default,,0000,0000,0000,,this portion of the test.
Dialogue: 0,0:07:20.31,0:07:23.94,Default,,0000,0000,0000,,The next question was about serial sevens.
Dialogue: 0,0:07:23.94,0:07:29.19,Default,,0000,0000,0000,,You'll notice that Sam got some of\Nthese correct, but others wrong.
Dialogue: 0,0:07:29.19,0:07:34.17,Default,,0000,0000,0000,,Therefore, he was able to correctly\Nsubtract seven two times,
Dialogue: 0,0:07:34.17,0:07:37.96,Default,,0000,0000,0000,,which corresponds to a score\Nof two out of three.
Dialogue: 0,0:07:37.96,0:07:41.01,Default,,0000,0000,0000,,And you can see underneath the numbers
Dialogue: 0,0:07:41.01,0:07:45.58,Default,,0000,0000,0000,,there are instructions about\Nhow to score this section.
Dialogue: 0,0:07:45.58,0:07:49.73,Default,,0000,0000,0000,,Under language, Sam was able to\Nrepeat both sentences correctly, so
Dialogue: 0,0:07:49.73,0:07:51.64,Default,,0000,0000,0000,,receives two out of two points.
Dialogue: 0,0:07:51.64,0:07:57.46,Default,,0000,0000,0000,,When he was asked to name words in one\Nminute that begin with the letter F,
Dialogue: 0,0:07:57.46,0:08:03.87,Default,,0000,0000,0000,,he was able to name more than eleven, and\Nso receives a full credit, one point.
Dialogue: 0,0:08:03.87,0:08:07.52,Default,,0000,0000,0000,,And for abstraction, for the first item,
Dialogue: 0,0:08:07.52,0:08:11.70,Default,,0000,0000,0000,,train and bicycle,\NSam struggled a little bit.
Dialogue: 0,0:08:11.70,0:08:17.38,Default,,0000,0000,0000,,His answer related to wheels that\Noperate in the same way or have elbows.
Dialogue: 0,0:08:17.38,0:08:20.39,Default,,0000,0000,0000,,And that's considered\Na more concrete response.
Dialogue: 0,0:08:20.39,0:08:25.27,Default,,0000,0000,0000,,The MoCA instructions detail out\Na little bit more specifically
Dialogue: 0,0:08:25.27,0:08:28.43,Default,,0000,0000,0000,,what is a good response or a bad response.
Dialogue: 0,0:08:28.43,0:08:32.83,Default,,0000,0000,0000,,For that item, the train and bicycle,\NSam did not not receive full credit.
Dialogue: 0,0:08:32.83,0:08:36.58,Default,,0000,0000,0000,,But he did answer appropriately when asked\Nabout the similarity between a watch
Dialogue: 0,0:08:36.58,0:08:37.20,Default,,0000,0000,0000,,and a ruler.
Dialogue: 0,0:08:37.20,0:08:41.63,Default,,0000,0000,0000,,So he receives one out of a total\Ntwo points in that direction.
Dialogue: 0,0:08:41.63,0:08:45.67,Default,,0000,0000,0000,,When Sam was asked to remember the words\Nthat were given to him earlier,
Dialogue: 0,0:08:45.67,0:08:49.37,Default,,0000,0000,0000,,unfortunately he was not able to\Nremember any of the words, and so
Dialogue: 0,0:08:49.37,0:08:50.72,Default,,0000,0000,0000,,received zero points.
Dialogue: 0,0:08:50.72,0:08:54.65,Default,,0000,0000,0000,,For the last section orientation,\NSam was able to answer all of those
Dialogue: 0,0:08:54.65,0:08:57.65,Default,,0000,0000,0000,,questions correctly, and\Nso received six points.
Dialogue: 0,0:08:57.65,0:09:01.49,Default,,0000,0000,0000,,When all of the sub components\Nare added together,
Dialogue: 0,0:09:01.49,0:09:05.16,Default,,0000,0000,0000,,Sam's total score on\Nthe MoCA is 21 over 30.
Dialogue: 0,0:09:05.16,0:09:09.24,Default,,0000,0000,0000,,Adding an extra point is not\Nnecessary because Sam has more than
Dialogue: 0,0:09:09.24,0:09:13.19,Default,,0000,0000,0000,,a high school education, so\Nhis total score is 21 points.
Dialogue: 0,0:09:13.19,0:09:18.15,Default,,0000,0000,0000,,The ACT on Alzheimer's website has\Nmany provider tools that simplify
Dialogue: 0,0:09:18.15,0:09:22.85,Default,,0000,0000,0000,,the screening process, and\Nalso provide simple instructions for
Dialogue: 0,0:09:22.85,0:09:26.40,Default,,0000,0000,0000,,what to do when patients pass and\Nfail the screen.
Dialogue: 0,0:09:26.40,0:09:31.13,Default,,0000,0000,0000,,For more information to\Ndownload these free tools,
Dialogue: 0,0:09:31.13,0:09:37.26,Default,,0000,0000,0000,,please visit the ACT on Alzheimer's\Nwebsite at the link provided,
Dialogue: 0,0:09:37.26,0:09:42.21,Default,,0000,0000,0000,,or you can also contact ACT\Non Alzheimer's staff using
Dialogue: 0,0:09:42.21,0:09:45.57,Default,,0000,0000,0000,,the information on the slide below.