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Protocol - Global Mental Status Screener - Adult

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Protocol Name from Source:

Montreal Cognitive Assessment (MOCA©)

Availability:

Publicly available

Description:

The Montreal Cognitive Assessment (MoCA©) is a screening instrument for mild cognitive impairment and more severe cognitive deficits. It is an interviewer-administered questionnaire in which the respondent performs certain tasks, such as drawing and counting, to assess various cognitive domains, such as attention, memory, orientation, language, conceptual thinking, and planning.

Protocol:

Please consult [link[www.mocatest.org|www.mocatest.org]] for permission and requirements to use the MoCA test.

[img[mental_status_adult_01.png|MoCA Test]]

Instructions:

1. Alternating Trail Making:

Administration: The examiner instructs the subject: "Please draw a line, going from a number to a letter in ascending order. Begin here [point to (1)] and draw a line from 1 then to A then to 2 and so on. End here [point to (E)]."

Scoring: Allocate one point if the subject successfully draws the following pattern: 1-A- 2- B- 3- C- 4- D- 5- E, without drawing any lines that cross. Any error that is not immediately self-corrected earns a score of 0.

2. Visuoconstructional Skills (Cube):

Administration: The examiner gives the following instructions, pointing to the cube: "Copy this drawing as accurately as you can, in the space below ".

Scoring: One point is allocated for a correctly executed drawing.

  • Drawing must be three-dimensional
  • All lines are drawn
  • No line is added
  • Lines are relatively parallel and their length is similar (rectangular prisms are accepted)

A point is not assigned if any of the above-criteria are not met.

3. Visuoconstructional Skills (Clock):

Administration: Indicate the right third of the space and give the following instructions: "Draw a clock. Put in all the numbers and set the time to 10 after 11 ".

Scoring: One point is allocated for each of the following three criteria:

  • Contour (1 pt.): the clock face must be a circle with only minor distortion acceptable (e.g., slight imperfection on closing the circle);
  • Numbers (1 pt.): all clock numbers must be present with no additional numbers; numbers must be in the correct order and placed in the approximate quadrants on the clock face; Roman numerals are acceptable; numbers can be placed outside the circle contour;
  • Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand must be clearly shorter than the minute hand; hands must be centered within the clock face with their junction close to the clock centre.

A point is not assigned for a given element if any of the above-criteria are not met.

4. Naming:

Administration: Beginning on the left, point to each figure and say: "Tell me the name this animal".

Scoring: One point each is given for the following responses: (1) camel or dromedary, (2) lion, (3) rhinoceros or rhino.

5. Memory:

Administration: The examiner reads a list of 5 words at a rate of one per second, giving the following instructions: "This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn't matter in what order you say them". Mark a check in the allocated space for each word the subject produces on this first trial. When the subject indicates that (s)he has finished (has recalled all words), or can recall no more words, read the list a second time with the following instructions: "I am going to read the same list for a second time. Try to remember and tell me as many words as you can, including words you said the first time." Put a check in the allocated space for each word the subject recalls after the second trial.

At the end of the second trial, inform the subject that (s)he will be asked to recall these words again by saying, "I will ask you to recall those words again at the end of the test. "

Scoring: No points are given for Trials One and Two.

6. Attention:

Forward Digit Span: Administration: Give the following instruction: "I am going to say some numbers and when I am through, repeat them to me exactly as I said them ". Read the five number sequence at a rate of one digit per second. Backward Digit Span: Administration: Give the following instruction: "Now I am going to say some more numbers, but when I am through you must repeat them to me the in the backwards order. " Read the three number sequence at a rate of one digit per second.

Scoring: Allocate one point for each sequence correctly repeated, (N.B.: the correct response for the backwards trial is 2-4-7).

Vigilance: Administration: The examiner reads the list of letters at a rate of one per second, after giving the following instruction: "I am going to read a sequence of letters. Every time I say the letter A, tap your hand once. If I say a different letter, do not tap your hand ".

Scoring: Give one point if there is zero to one errors (an error is a tap on a wrong letter or a failure to tap on letter A).

Serial 7s: Administration: The examiner gives the following instruction: "Now, I will ask you to count by subtracting seven from 100, and then, keep subtracting seven from your answer until I tell you to stop. " Give this instruction twice if necessary.

Scoring: This item is scored out of 3 points. Give no (0) points for no correct subtractions, 1 point for one correction subtraction, 2 points for two-to-three correct subtractions, and 3 points if the participant successfully makes four or five correct subtractions. Count each correct subtraction of 7 beginning at 100. Each subtraction is evaluated independently; that is, if the participant responds with an incorrect number but continues to correctly subtract 7 from it, give a point for each correct subtraction. For example, a participant may respond "92 - 85 - 78 -71 - 64" where the "92" is incorrect, but all subsequent numbers are subtracted correctly. This is one error and the item would be given a score of 3.

7. Sentence repetition:

Administration: The examiner gives the following instructions: "I am going to read you, a sentence. Repeat it after me, exactly as I say it [pause]: I only know that John is the one to help today." Following the response, say: "Now I am going to read you another sentence. Repeat it after me, exactly as I say it [pause]: The cat always hid under the couch when dogs were in the room."

Scoring: Allocate 1 point for each sentence correctly repeated. Repetition must be exact. Be alert for errors that are omissions (e.g., omitting "only", "always") and substitutions/additions (e.g., "John is the one who helped today;" substituting "hides" for "hid", altering plurals. etc.).

8. Verbal fluency:

Administration: The examiner gives the following instruction: "Tell me as many words as you can think of that begin with a certain letter of the alphabet that I will tell you in a moment. You can sav any kind of word you want, except for proper nouns (like Bob or Boston), numbers, or words that begin with the same sound but have a different suffix, for example, love, lover, loving. I will tell you to stop after one minute. Are you read? [Pause] Now, tell me as many words as you can think of that begin with the letter F. [time for 60 sec]. Stop. "

Scoring: Allocate one point if the subject generates 11 words or more in 60 sec. Record the subject's response in the bottom or side margins.

9. Abstraction:

Administration: The examiner asks the subject to explain what each pair of words has in common, starting with the example: "Tell me how an orange and a banana are alike ". If the subject answers in a concrete manner, then say only one additional time: "Tell me another way in which those items are alike". If the subject does not give the appropriate response (fruit), say, "Yes, and they are also both fruit." Do not give any additional instructions or clarification.

After the practice trial, say: "Now, tell me how a train and a bicycle are alike ". Following the response, administer the second trial, saying: "Now tell me how a ruler and a watch are alike." Do not give any additional instructions or prompts.

Scoring: Only the last two item pairs are scored. Give 1 point to each item pair correctly answered. The following responses are acceptable:

Train-bicycle = means of transportation, means of travelling, you take trips in both;

Ruler-watch = measuring instruments, used to measure.

The following responses are not acceptable: Train-bicycle = they have wheels; Ruler-watch = they have numbers.

10. Delayed recall:

Administration: The examiner gives the following instruction: "I read some words to you earlier, which I asked you to remember. Tell me as many of those words as you can remember. Make a check mark (√) for each of the words correctly recalled spontaneously without any cues, in the allocated space.

Scoring: Allocate 1 point for each word recalled freely without any cues.

Optional:

Following the delayed free recall trial, prompt the subject with the semantic category cue provided below for any word not recalled. Make a check mark (√) in the allocated space if the subject remembered the word with the help of a category or multiple-choice cue. Prompt all non-recalled words in this manner. If the subject does not recall the word after the category cue, give him/her a multiple choice trial, using the following example instruction, "Which of 'the following words do you think it was, NOSE, FACE, or HAND?"

Use the following category and/or multiple-choice cues for each word, when appropriate:

FACE:

category cue: part of the body

multiple choice: nose, face, hand

VELVET:

category cue: type of fabric

multiple choice: denim, cotton, velvet

CHURCH:

category cue: type of building

multiple choice: church, school, hospital

DAISY:

category cue: type of flower

multiple choice: rose, daisy, tulip

RED:

category cue: a colour

multiple choice: red, blue, green

Scoring: No points are allocated for words recalled with a cue. A cue is used for clinical information purposes only and can give the test interpreter additional information about the type of memory disorder. For memory deficits due to retrieval failures, performance can be improved with a cue. For memory deficits due to encoding failures, performance does not improve with a cue.

11. Orientation:

Administration: The examiner gives the following instructions: "Tell me the date today ". If the subject does not give a complete answer, then prompt accordingly by saying: 'Tell me the [year, month, exact date, and day of the week]. " Then say: "Now, tell me the name of this place, and which city it is in. "

Scoring: Give one point for each item correctly answered. The subject must tell the exact date and the exact place (name of hospital, clinic, office). No points are allocated if subject makes an error of one day for the day and date.

TOTAL SCORE: Sum all subscores listed on the right-hand side. Add one point for an individual who has 12 years or fewer of formal education, for a possible maximum of 30 points. A final total score of 26 and above is considered normal.

Please consult www.mocatest.org for permission and requirements to use the MoCA test.
Copyright© 2003 to 2010 The Montreal Cognitive Assessment - MoCA© - All rights reserved

Personnel and Training Required

Personnel should be trained by a licensed neuropsychologist or other trained medical professional experienced with the Montreal Cognitive Assessment (MoCA©). Additionally, investigators are encouraged to have quality control procedures (such as videotaping sessions, etc.) in place to maintain consistency across examiners.

Equipment Needs

The interviewer will need a copy of the test and a copy of the administration and scoring instructions.

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Interviewer (face-to-face)

Life Stage:

Adult, Senior

Specific Instructions:

Please consult www.mocatest.org for permission and requirements to use the Montreal Cognitive Assessment (MoCA©) test.

Research Domain Information

Release Date:

May 12, 2010

Definition

A test to assess the respondent’s overall mental capability.

Purpose

This measure quickly screens a variety of cognitive domains to determine a respondent’s general mental status. It can be used to detect impaired mental status caused by a variety of conditions, including head injury, stroke, infections, brain tumors, developmental defects, and neurodegenerative disorders such as Alzheimer’s disease.

Selection Rationale

The Montreal Cognitive Assessment (MoCA©) was selected because it is a free, validated instrument that can be completed in 10 minutes and more sensitive than comparable instruments for detecting mild cognitive dysfunction and mild dementia due to conditions such as Alzheimer’s disease.

Language

Afrikaans, Arabic, Cantonese Chinese, Croatian, Czech, Danish, Dutch, English, Estonian, Finnish, French, German, Greek, Hebrew, Italian, Japanese, Korean, Mandarin Chinese, Polish, Portugese, Russian, Serbian, Spanish, Swedish, Thai, Turkish, Ukrainian, Vietnamese

Standards

StandardNameIDSource
Common Data Elements (CDE)Adult Cognitive Assessment Score3076130CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Global mental status adult proto62769-5LOINC

Process and Review

[link[phenx.org/node/103|Expert Review Panel 4]] (ERP 4) reviewed the measures in the Neurology, Psychiatric, and Psychosocial domains.

Guidance from ERP 4 included the following:

· No changes

Source

The Montreal Cognitive Assessment (MoCA©), Version 7.1, November 12, 2004, is under copyright and can be obtained through:

Dr. Ziad Nasreddine
Center for Diagnosis & Research on Alzheimer’s disease (CEDRA)
4896 Taschereau Blvd, Suite 250
Greenfield Park (Quebec) Canada J4V 2J2
info@mocatest.org

General References

Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699.

Protocol ID:

130701

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX130701_Alternate_Trail_MakingPX130701010000Please draw a line, going from a number to a letter in ascending order. Begin here [point to (1)] and draw a line from 1 then to A then to 2 and so on. End here [point to (E)]."4N/A
PX130701_Visuoconstructional_Skills_CubePX130701020000Copy this drawing as accurately as you can, in the space below4N/A
PX130701_Visuoconstructional_Skills_ClockPX130701030000Draw a clock. Put in all the numbers and set the time to 10 after 11.4N/A
PX130701_Naming_CamelPX130701030100Tell me the name this animal4N/A
PX130701_Naming_LionPX130701030200Tell me the name this animal4N/A
PX130701_Naming_RhinocerosPX130701030300Tell me the name this animal4N/A
PX130701_Immediate_Recall_Face_Trial1PX130701040100This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn't matter in what order you say them. Face4N/A
PX130701_Immediate_Recall_Velvet_Trial1PX130701040200This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn't matter in what order you say them. Velvet4N/A
PX130701_Immediate_Recall_Church_Trial1PX130701040300This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn't matter in what order you say them. Church4N/A
PX130701_Immediate_Recall_Daisy_Trial1PX130701040400This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn't matter in what order you say them. Daisy4N/A
PX130701_Immediate_Recall_Red_Trial1PX130701040500This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn't matter in what order you say them. Red4N/A
PX130701_Immediate_Recall_Face_Trial2PX130701050100I am going to read the same list for a second time. Try to remember and tell me as many words as you can, including words you said the first time. Face4N/A
PX130701_Immediate_Recall_Velvet_Trial2PX130701050200I am going to read the same list for a second time. Try to remember and tell me as many words as you can, including words you said the first time. Velvet4N/A
PX130701_Immediate_Recall_Church_Trial2PX130701050300I am going to read the same list for a second time. Try to remember and tell me as many words as you can, including words you said the first time. Church4N/A
PX130701_Immediate_Recall_Daisy_Trial2PX130701050400I am going to read the same list for a second time. Try to remember and tell me as many words as you can, including words you said the first time. Daisy4N/A
PX130701_Immediate_Recall_Red_Trial2PX130701050500I am going to read the same list for a second time. Try to remember and tell me as many words as you can, including words you said the first time. Red4N/A
PX130701_Digit_Span_ForwardPX130701060100I am going to say some numbers and when I am through, repeat them to me exactly as I said them. 2,1,8,5,44N/A
PX130701_Digit_Span_BackwardPX130701060200Now I am going to say some more numbers, but when I am through you must repeat them to me the in the backwards order. 7,4,24N/A
PX130701_VigilancePX130701070000I am going to read a sequence of letters. Every time I say the letter A, tap your hand once. If I say a different letter, do not tap your hand. F,B,A,C,M,N,A,A,J,K,L,B,A,F,A,K,D,E,A,A,A,J,A,M,O,F,A,A,B4N/A
PX130701_Serial_SevensPX130701080000Now, I will ask you to count by subtracting seven from 100, and then, keep subtracting seven from your answer until I tell you to stop.4N/A
PX130701_Sentence_Repetition_2PX130701090200Now I am going to read you another sentence. Repeat it after me, exactly as I say it [pause]: The cat always hid under the couch when dogs were in the room.4N/A
PX130701_Verbal_FluencyPX130701100000Tell me as many words as you can think of that begin with a certain letter of the alphabet that I will tell you in a moment. You can sav any kind of word you want, except for proper nouns (like Bob or Boston), numbers, or words that begin with the same sound but have a different suffix, for example, love, lover, loving. I will tell you to stop after one minute. Are you ready? [Pause] Now, tell me as many words as you can think of that begin with the letter F. [time for 60 sec]. Stop.4N/A
PX130701_Abstraction_1PX130701110100Now, tell me how a train and a bicycle are alike.4N/A
PX130701_Abstraction_2PX130701110200Now tell me how a ruler and a watch are alike.4N/A
PX130701_Sentence_Repetition_1PX130701090100I am going to read you, a sentence. Repeat it after me, exactly as I say it [pause]: I only know that John is the one to help today.4N/A