POINTS
MONTREAL COGNITIVE ASSESSMENT (MoCA ®)
Version 8.3 English
NAMING
Name:
Education:
Sex:
Date of birth :
DATE :
Copy bed
Draw CLOCK (Five past ten)
(3 points)
[] [] [] [] []
/ 5
/ 3
/ 2
/ 1
/ 3
/ 2
/ 1
/ 2
/ 5
/ 6
NO
POINTS
Read list of digits (1 digit / sec.).
Serial 7 subtraction starting at 60.
Repeat: The child walked his dog in the park after midnight.
Language Fluency. Name maximum number of words in one minute that begin with the letter B.
Similarity between e.g. banana - orange = fruit
Category cue
MIS = / 15
Multiple choice cue
Memory
Index Score
(MIS)
Has to recall words
WITH NO CUE
Points for
UNCUED
recall only
(MIS)
X3
X2
X1
hammer - screwdriver matches - lamp
The artist finished his painting at the right moment for the exhibition.
LEG
COTTON SCHOOL TOMATO WHITE
NumbersContour Hands
[] [] []
[]
[] [] []
Read list of words, subject must
repeat them. Do 2 trials, even if 1st trial is successful.
Do a recall after 5 minutes.
ME
MORY
ATTENTION
LANGUAGE
ABSTRACTION
DELAYED RECALL
ORIENTATION
LEG COTTON SCHOOL TOMATO WHITE
1st TRIAL
[]
[]
Subject has to repeat them in the forward order.
2 4 8 1 5
4 2 7
Subject has to repeat them in the backward order.
[]
[]
53
[]
[]
[]
[]
[] []
[] [] []
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 B
Read list of letters. The subject must tap with his hand at each letter A. No points if ≥ 2 errors.
4 or 5 correct subtractions: 3 pts, 2 or 3 correct: 2 pts, 1 correct: 1 pt, 0 correct: 0 pt
(N ≥ 11 words)
[]
Date
[]
Month
[]
Year
[]
Day
[]
Place
[]
City
46 39 32 25
www.mocatest.org
/ 30
TOTAL
© Z. Nasreddine MD
Administered by:
Training and Certification are required to ensure accuracy.
MIS: /15
( Normal ≥ 26/30)
Add 1 point if ≤ 12 yr education
2nd TRIAL
[]
VISUOSPATIAL / EXECUTIVE
