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).
MoCA Score Interpreter
Score at or above the commonly used screening threshold. Does not rule out subjective cognitive concerns or early change.
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. |
| 18–25 | Mild impairmentBelow the ≥26 screening threshold; consistent with mild cognitive impairment range. Further clinical evaluation recommended. |
| 10–17 | Moderate impairmentModerate range by clinical convention. Comprehensive evaluation and care planning warranted. |
| 0–9 | Severe 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. Educational reference only — not a diagnostic tool.
For reference only — not an assessment, diagnosis, or medical advice. This page provides scoring reference material; interpretation and clinical decisions rest with a qualified clinician.
What the MoCA measures
The Montreal Cognitive Assessment (MoCA) was developed by Ziad Nasreddine and colleagues and published in the Journal of the American Geriatrics Society in 2005. It was specifically designed to address a critical gap in clinical practice: the MMSE's poor sensitivity for detecting mild cognitive impairment (MCI), a pre-dementia state that is an important target for early intervention. The MoCA achieves 90% sensitivity and 87% specificity for MCI, compared to the MMSE's 18% sensitivity, making it the preferred brief cognitive screen when early-stage impairment is suspected.
The MoCA assesses eight cognitive domains across 30 scored items. Unlike the MMSE, which devotes minimal items to executive function, the MoCA includes a Trail-Making task, a clock drawing task, and a Cube copying task within the Visuospatial/Executive domain (5 points). Additional domains include Naming of three animals (3 points), Memory encoding (5 words; not scored at encoding, scored at Delayed Recall), Attention including forward and backward digit span, vigilance, and serial subtraction (6 points), Language including sentence repetition and verbal fluency (3 points), Abstraction (2 points), Delayed Recall of the five encoded words (5 points), and Orientation (6 points).
One additional point is added to the raw score for patients with 12 or fewer years of formal education, giving an education-adjusted maximum of 30. 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, and posting the test on other websites is not allowed. It has been translated into over 90 languages. It is widely used in neurology, geriatrics, stroke rehabilitation, Parkinson's disease management, and memory clinic programs.
How to administer 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.
MoCA domain scoring guide
Clinician-administered. Enter the score for each domain to calculate the total MoCA score. Add 1 point if the patient has ≤12 years of education.
Education Adjustment
Add 1 point if patient has ≤12 years of formal education
Clinician reference tool only. Cannot replace individualized clinical evaluation.
MoCA scoring and interpretation
Nasreddine et al. (2005) cutoffs. Score is the sum across 8 domains (maximum 30, plus 1 education point if applicable). Higher scores indicate better cognitive functioning.
Education correction
One point is added to the raw MoCA score for patients with 12 or fewer years of formal education. This correction is applied before interpreting the score against the ≥26 normal threshold. The maximum adjusted score remains 30. Clinicians should also consider whether language barriers or visual or motor impairments may affect performance on specific tasks.
The education correction was derived from the original validation study comparing educated and less-educated cognitively normal participants.
Psychometric properties
In the original validation study (Nasreddine et al., 2005; 94 patients with MCI, 93 with mild Alzheimer's disease, and 90 healthy controls), a cutoff of 26 detected 90% of MCI cases, against 18% for the MMSE, and 100% of mild Alzheimer's disease cases, against 78% for the MMSE. Specificity was 87% for the MoCA and 100% for the MMSE.
Later work suggests the original cutoff produces too many false positives. A systematic review and meta-analysis by Carson and colleagues (2018) found that a cutoff of 23/30 gave the best overall diagnostic accuracy. A 2023 meta-analysis of 13 studies (2,158 participants) by Islam and colleagues reported sensitivity of 73.5% and specificity of 91.3% at a cutoff of <23, 79.5% and 83.7% at <24, and 83.8% and 70.8% at <25, while noting that high or unclear risk of bias limits confidence in these estimates.
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.
MoCA Cognitive Domains
Eight domains assessed across 30 items. The MoCA's detailed executive function and memory assessment distinguishes it from the MMSE.
Visuospatial / Executive
Trail-making alternation task (1), cube copy (1), clock drawing, contour, numbers, hands (3). Tests visuospatial reasoning and frontal executive ability.
Naming
Patient names three line-drawn animals. One point per correct response. Assesses language and semantic memory.
Attention
Forward digit span (1), backward digit span (1), sustained attention / vigilance tapping task (1), serial 7 subtraction from 100, three correct = 3 pts, two = 2, one = 1 (3 pts).
Language
Repeat two complex sentences (2 pts) and a one-minute letter fluency task, scoring 1 point for 11 or more words (1 pt).
Abstraction
Two conceptual similarity tasks: the patient explains how two items are alike. One point each. Assesses abstract reasoning.
Delayed Recall
Free recall of the five words encoded at the Memory section, 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
Date (1), month (1), year (1), day of week (1), place (1), and city (1). Six orientation items covering both time and place. One point each.
Memory Encoding (Not Scored)
The five words are read aloud twice at encoding and the patient repeats them, but no score is assigned at this stage. Scores are only recorded at Delayed Recall approximately 5 minutes later.
MoCA in Clinical Practice
The MoCA is used for MCI detection, dementia monitoring, stroke cognitive assessment, and Parkinson's disease cognitive evaluation.
MCI Detection
The MoCA was specifically designed and validated for MCI detection. Its Trail-Making, clock drawing, and five-word recall tasks are more sensitive to the subtle executive and memory deficits characteristic of MCI than the simpler tasks on the MMSE. A score of 25 or below on the MoCA is associated with clinical identification of MCI in the original validation cohort.
In the Nasreddine et al. (2005) validation study, the MoCA detected 90% of MCI cases compared to 18% for the MMSE.
Parkinson's Disease
The MoCA is the recommended cognitive screen for Parkinson's disease (PD). Cognitive impairment affects approximately 25–30% of PD patients at initial presentation, and the MoCA's visuospatial and executive tasks are particularly sensitive to the frontal-subcortical profile of PD-associated cognitive decline, which the MMSE frequently misses.
Movement Disorder Society (MDS) guidelines recommend the MoCA as the Level I screening tool in Parkinson's disease cognitive impairment.
Stroke Rehabilitation
Post-stroke cognitive impairment affects 30–40% of stroke survivors and significantly impacts rehabilitation outcomes. The MoCA is recommended for routine cognitive screening in stroke rehabilitation settings due to its sensitivity to vascular cognitive impairment patterns, including attention and executive deficits that are common after stroke but missed by the MMSE.
Canadian Best Practice Recommendations for Stroke include the MoCA as the preferred cognitive screening tool for the post-stroke population.
Measuring cognition in HiBoop
HiBoop does not offer the MoCA; this page is reference material. For cognitive and functional change, HiBoop offers the IQCODE-SR and IADL, with automated scoring and tracking over time.
HiBoop does not offer this scale. This page is reference material.This library is an academic and clinical reference. A scale described here is not necessarily offered in HiBoop; each page says whether it is.
Frequently Asked Questions
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 patients 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). One bonus point is added for patients with 12 or fewer years of formal education, making the maximum adjusted total 30. Higher scores indicate better cognitive functioning.
Bill this assessment
The MoCA (Montreal Cognitive Assessment) qualifies for reimbursement under these CPT codes (US).
Measurement-based care in practice
For clinicians
HiBoop does not offer this scale. For the scales it does offer, HiBoop automates delivery, scoring and longitudinal tracking across your patient panel.
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.
References
- 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.View source
- 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.View source
- 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.View source
Last reviewed: Jun 3, 2026
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