What is the Montreal Cognitive Assessment (MoCA)?

Therapists and clinicians have a variety of ways to assess clients’ health—including the Montreal Cognitive Assessment (commonly referred to as the MoCA).

The Montreal Cognitive Assessment can be a helpful tool for evaluating certain types of clients—and ensuring those clients get the care and support they need. 

But who and what, exactly, does the MoCA assess? And how can you effectively use it in your practice?

What is the MoCA—and who is it for?

First things first, what is the Montreal Cognitive Assessment?

“The Montreal Cognitive Assessment, or MoCA, is a screening tool designed to help identify cognitive impairments,” says Kristie Tse, LMHC, founder and clinical director of NYC-based Uncover Mental Health Counseling. “It covers a range of cognitive domains, such as memory, attention, language, and executive function.” 

Who is the Montreal Cognitive Assessment primarily useful for?

“This tool is primarily used with adults, especially those where there’s a concern about mild cognitive impairment (MCI) or early signs of dementia,” Tse says.

That being said, there are other applications. “I’ve also seen it used in other cases, like post-stroke recovery or assessing cognitive changes after brain injuries.”

One important thing to note is that while the MoCA is a screening tool, it’s not necessarily a diagnostic one.

“I like to think of it as a broad ‘snapshot’ of someone’s mental health,” says Tse. “It’s not meant to provide a diagnosis independently, but it’s incredibly helpful for flagging potential issues that might need further evaluation.”

‌

What does the MoCA assess?

As mentioned above, the Montreal Cognitive Assessment is used to assess a variety of cognitive impairments. 

“These include short-term memory recall, visuospatial abilities… attention span, problem-solving, and even some basic language comprehension,” says Tse.

And not only is the MoCA designed to assess a variety of cognitive impairments, but also impairments related to a variety of conditions, including:

• Alzheimer’s disease
• Parkinson’s disease
• Huntington’s disease
• Lewy Body Dementia
• VCI/Stroke
• Fronto-temporal dementia
• Brain metastasis
• ALS
• Sleep behavior disorder
• Brain tumors
• Multiple sclerosis
• Head trauma
• Depression
• Schizophrenia
• Heart failure
• Substance abuse
• HIV
• COVID

How is the MoCA administered and scored—and how are MoCA scores interpreted?

Now that you know what the Montreal Cognitive Assessment is (and what it assesses), let’s jump into how it’s administered and scored—or, to put it another way, MoCA instructions.

“The MoCA exam is usually a pen-and-paper test that takes about 10-15 minutes to complete,”says Tse. 

The Montreal Cognitive Assessment consists of 30 questions/exercises designed to test different types of cognitive functioning (for example, testing memory by reading a list of words and having the participant repeat them back or testing visuoconstructional skills by asking participants to replicate a drawing of a cube)—each of which are worth one point.

In terms of scoring, “the maximum MoCA score is 30—and typically, a score of 26 or above is considered ‘normal,’” says Tse. 

While the scoring system is simple and straightforward, MoCA score interpretation is less so.

“Lower scores can suggest potential cognitive difficulties—but interpretation needs context,” says Tse. “For instance, I always consider the client’s baseline functioning and any external factors—for example, language barriers or anxiety during testing—that could affect their performance.”

“As with any cognitive assessment, results should be interpreted alongside other clinical information,” Tse continues. “It’s important to approach the scoring with an open mind and consider things like education and cultural background, since these can influence performance.”

How does the MoCA compare to the MMSE (Mini-Mental State Examination)?

The Montreal Cognitive Assessment is one of many assessments for evaluating mental health and functioning—as is the Mini-Mental State Examination (often known as the MMSE).

This can bring up the question: when it comes to MMSE vs. MoCA, how are they the same—and how are they different?

Both the MMSE and MoCA assessment are cognitive screening tools—but the main difference is that the Montreal Cognitive Assessment is considered more comprehensive.

“The Montreal Cognitive Assessment is a bit more sensitive, especially for detecting mild impairments,” says Tse. “It covers a broader range of cognitive functions than the MMSE, so I often lean towards the MoCA when I suspect subtle issues that the MMSE might miss.”

‌

Tips for incorporating the MoCA in your practice

Thinking about using the Montreal Cognitive Assessment to assess clients—and improve your patient care in the process? 

Here are a few tips to keep in mind:

Make sure your client is comfortable

Many people feel uncomfortable or nervous taking tests of any sort—including cognitive assessments. 

And, if a client is nervous, it could impact their ability to focus and tackle the test questions—which, in turn, can impact results. 

That’s why it’s important to connect with your client and make sure they feel comfortable before you administer the assessment. 

“Create a supportive environment for the test,” says Tse. Building rapport beforehand helps the client feel comfortable.

Use the MoCA as one part of a larger assessment puzzle

While the MoCA can be a helpful tool in assessing cognitive impairment, it shouldn’t be the only tool you rely on. 

Don’t jump to conclusions based on scores alone; instead, use them (along with other assessments) to help you better understand your clients and feel out the best next steps. 

“Focus on interpretation—scores are just one part of the picture,” says Tse. “Use them to decide the next steps, like referring the client for further testing or intervention.”

Seek training

In order to get the best results from the Montreal Cognitive Assessment , you need to know how to effectively administer and score the assessment—which means training is a must. 

“Stay updated on MoCA training to refine your approach and ensure consistency,” says Tse.

____

Sources

• ScienceDirect. Montreal Cognitive Assessment.
• National Library of Medicine National Center for Biotechnology Information. Montreal Cognitive Assessment as a screening tool.
• San Mateo County Health. Montreal Cognitive Assessment (MoCA) Administration and Scoring Instructions.
• MoCA Cognition. 

How SimplePractice streamlines running your practice

SimplePractice is HIPAA-compliant practice management software with everything you need to run your practice built into the platform—from booking and scheduling to insurance and client billing.

If you’ve been considering switching to an EHR system, SimplePractice empowers you to run a fully paperless practice—so you get more time for the things that matter most to you.

Try SimplePractice free for 30 days. No credit card required.

‌