Interactive Interpreter

MoCA (Montreal Cognitive Assessment)

The MoCA (Montreal Cognitive Assessment) is a 30-point clinician-administered cognitive screening test that takes about 10 minutes and helps detect mild cognitive impairment across 8 domains. Score 0–30 (+1 for ≤12 years education); ≥26 is the original normal cutoff, with 90% sensitivity for MCI (Nasreddine et al., 2005).

For professional reference, research, and education only. Not for diagnosis or medical advice.

MoCA Score Interpreter

  • Enter a total score to see its range.

  • 30 items across 8 domains; add 1 point for ≤12 years education before scoring. Higher scores indicate better cognitive functioning.

    Total score (education-adjusted)Interpretation
    26+Normal rangeScore at or above the commonly used screening threshold. Does not rule out subjective cognitive concerns or early change.
    18–25Mild impairmentBelow the ≥26 screening threshold; consistent with mild cognitive impairment range. Further clinical evaluation recommended.
    10–17Moderate impairmentModerate range by clinical convention. Comprehensive evaluation and care planning warranted.
    0–9Severe impairmentScore below 10 indicates severe cognitive impairment by clinical convention. Immediate clinical evaluation required.

    Nasreddine et al. 2005 established the ≥26 screening cutoff (J Am Geriatr Soc 53:695–699). Carson et al. 2018 (Int J Geriatr Psychiatry 33:379–388) found a cutoff of 23 reduces false positives in older and less-educated adults. Graded severity bands below (mild/moderate/severe) reflect commonly used clinical convention, not the original validation study.

The MoCA (Montreal Cognitive Assessment) is a 30-point, clinician-administered cognitive screen that takes about 10 minutes and was built to detect mild cognitive impairment (MCI), a state that often progresses to dementia [1].

What does the MoCA measure?

The MoCA measures performance across eight cognitive domains: visuospatial and executive function, naming, memory, attention, language, abstraction, delayed recall and orientation.

It was developed by Ziad Nasreddine and colleagues and published in 2005 to fill a gap in practice: the MMSE misses most people with MCI. At a cutoff of 26, the MoCA detected 90% of people with MCI against 18% for the MMSE, with 87% specificity [1].

Unlike the MMSE, which gives few items to executive function, the MoCA includes a trail-making task, a cube copy and a clock drawing within its visuospatial/executive domain. The full breakdown is under the cognitive domains section below.

Terms of use

The MoCA is copyrighted and its terms are set at mocacognition.com:

  • Training and certification have been mandatory to administer and score it since 2019.
  • Non-commercial clinical and educational use needs no written permission; research use needs permission.
  • Commercial or pharma-funded use needs a written licensing agreement.
  • Posting the test on other websites is not allowed.

It has been translated into over 90 languages and is widely used in neurology, geriatrics, stroke rehabilitation, Parkinson's disease care and memory clinics.

How do you give the MoCA?

The MoCA is clinician-administered and takes approximately 10 minutes. A trained health professional reads instructions, presents stimulus cards, and scores responses in real time across eight domains. It cannot be validly self-administered because several tasks, including the clock drawing, cube copy, and verbal fluency items, require direct clinician observation and standardized prompting.

The clinician totals the domain scores, then adds 1 point when the person has 12 or fewer years of formal education. This page is a clinician reference only and cannot replace individualized clinical evaluation.

How do you score and interpret the MoCA?

The score is the sum across the eight domains, to a maximum of 30, with 1 education point added where it applies. Higher scores indicate better cognitive functioning. The original study set 26 or above as the normal range [1]; the mild, moderate and severe ranges in the scorer are clinical convention, not bands from that study.

Education correction

One point is added to the raw MoCA score for people with 12 or fewer years of formal education. The correction is applied before the score is compared with the ≥26 normal threshold, and the maximum adjusted score remains 30.

The correction came from the original validation study [1]. Also consider whether language barriers or visual or motor impairments may affect performance on specific tasks.

Psychometric properties

The original validation study included 94 people with MCI, 93 with mild Alzheimer's disease and 90 healthy older controls. At a cutoff of 26:

  • MCI: the MoCA detected 90% of cases, against 18% for the MMSE [1].
  • Mild Alzheimer's disease: the MoCA detected 100% of cases, against 78% for the MMSE [1].
  • Specificity: 87% for the MoCA and 100% for the MMSE [1].

Later work suggests the original cutoff produces too many false positives, particularly in older and less educated adults:

  • A 2018 systematic review and meta-analysis of 9 studies found that a cutoff of 23/30 gave the best overall diagnostic accuracy [2].
  • A 2023 meta-analysis of 13 studies (2,158 participants) reported sensitivity 73.5% and specificity 91.3% at <23, 79.5% and 83.7% at <24, and 83.8% and 70.8% at <25. High or unclear risk of bias limits confidence in these estimates [3].

Limitations

  • Screening, not diagnosis. A below-threshold score indicates a need for further assessment; it does not diagnose dementia, MCI, or any specific neurodegenerative condition.
  • Cutoff uncertainty. The original ≥26 threshold inflates false positives, particularly in older adults and those with lower education; the optimal cutoff varies by setting.
  • Graded severity bands are convention. The mild, moderate, and severe ranges are commonly used clinical conventions, not bands from the original validation study.
  • Performance factors. Language barriers and visual or motor impairments can lower scores on specific tasks independent of cognition.
  • Clinician-administered. It requires a trained administrator and cannot be validly self-administered.

What are the MoCA's cognitive domains?

Eight domains are assessed across 30 points. The MoCA's detailed executive function and memory tasks distinguish it from the MMSE.

Visuospatial / executive (5 points)

Trail-making alternation task (1), cube copy (1), clock drawing: contour, numbers, hands (3). Tests visuospatial reasoning and frontal executive ability.

Naming (3 points)

The person names three line-drawn animals. One point per correct response. Assesses language and semantic memory.

Memory encoding (not scored)

Five words are read aloud twice and the person repeats them, but no score is assigned at this stage. Scores are recorded at delayed recall about 5 minutes later.

Attention (6 points)

Forward digit span (1), backward digit span (1), sustained attention / vigilance tapping task (1), serial 7 subtraction from 100: three correct = 3 points, two = 2, one = 1 (3).

Language (3 points)

Repeat two complex sentences (2) and a one-minute letter fluency task, scoring 1 point for 11 or more words (1).

Abstraction (2 points)

Two conceptual similarity tasks: the person explains how two items are alike. One point each. Assesses abstract reasoning.

Delayed recall (5 points)

Free recall of the five words encoded earlier, after approximately 5 minutes. One point per word recalled without prompting. (Test stimuli are not reproduced here: the MoCA's terms prohibit posting test content.)

Orientation (6 points)

Date (1), month (1), year (1), day of week (1), place (1), and city (1). One point each, covering both time and place.

Where is the MoCA used?

The MoCA is used for MCI detection, dementia monitoring, cognitive screening after stroke, and cognitive evaluation in Parkinson's disease.

MCI detection

The MoCA was designed and validated for MCI detection. Its trail-making, clock drawing and five-word recall tasks target the subtle executive and memory deficits of MCI that the simpler MMSE tasks miss. In the original validation cohort, it detected 90% of MCI cases against 18% for the MMSE [1].

Parkinson's disease

In a movement disorders centre sample of 114 people with Parkinson's disease, the MoCA was generally better suited than the MMSE. The best cutoffs were [4]:

  • Parkinson's disease dementia: <21 (sensitivity 81%, specificity 95%) [4].
  • MCI in Parkinson's disease: <26 (sensitivity 90%, specificity 75%) [4].

Stroke rehabilitation

Post-stroke cognitive impairment is a serious complication of stroke that affects quality of life. The MoCA and the MMSE are the two screens most widely used in stroke settings [5].

A 2025 meta-analysis of 9 studies (1,135 participants) found pooled sensitivity 80% and specificity 79% for the MoCA, with no significant difference from the MMSE. Most studies were at high risk of bias [5].

For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.

Related

FAQ

  • Is the MoCA self-reported or clinician-administered?

    The MoCA is clinician-administered. A trained health professional reads instructions, presents stimulus cards, and scores responses in real time across eight domains. Administration takes approximately 10 minutes. It cannot be validly self-administered because several tasks — including the clock drawing, cube copy, and verbal fluency items — require direct clinician observation and standardized prompting.

  • What is a normal MoCA score?

    A raw score of 26 or above is the commonly used threshold for normal cognition, as established in the Nasreddine et al. (2005) validation study. However, subsequent research — including a 2018 systematic review and meta-analysis by Carson and colleagues — found that a cutoff of 23 may reduce false positives, particularly in older adults and those with lower educational attainment. One point is added to the raw score for people with 12 or fewer years of education before comparing to any threshold. Scores must always be interpreted alongside clinical history and functional status.

  • Can the MoCA diagnose dementia or Alzheimer's disease?

    No. The MoCA is a screening tool, not a diagnostic test. A below-threshold score indicates a need for further assessment but does not constitute a diagnosis of dementia, mild cognitive impairment, or any specific neurodegenerative condition. Diagnosis requires comprehensive neuropsychological evaluation, clinical history, functional assessment, and often neuroimaging or laboratory investigations.

  • How is the MoCA scored, and what does each domain contribute?

    The MoCA is scored out of 30 points across eight domains: Visuospatial/Executive (5 points), Naming (3 points), Attention (6 points), Language (3 points), Abstraction (2 points), Delayed Recall (5 points), and Orientation (6 points); memory encoding is not scored. One bonus point is added for people with 12 or fewer years of formal education, making the maximum adjusted total 30. Higher scores indicate better cognitive functioning.

References

    1. 1.Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699.
    2. 2.Carson N, Leach L, Murphy KJ. A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores. Int J Geriatr Psychiatry. 2018;33(2):379-388.
    3. 3.Islam N, Hashem R, Gad M, Brown A, Levis B, Renoux C, Thombs BD, McInnes MD. Accuracy of the Montreal Cognitive Assessment tool for detecting mild cognitive impairment: a systematic review and meta-analysis. Alzheimers Dement. 2023;19(7):3235-3243.
    4. 4.Dalrymple-Alford JC, MacAskill MR, Nakas CT, et al. The MoCA: well-suited screen for cognitive impairment in Parkinson disease. Neurology. 2010;75(19):1717-1725.
    5. 5.Wei X, Liu Y, Li J, et al. MoCA and MMSE for the detection of post-stroke cognitive impairment: a comparative diagnostic test accuracy systematic review and meta-analysis. J Neurol. 2025;272(6):407.

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