Montreal Cognitive Assessment (MoCA): Dr. Zeid … Cognitive Assessment... · Spanish Thai. MoCA:...

Charles J. Vella, PhD

2010

Montreal Cognitive Assessment (MoCA):

Dr. Zeid Nasreddine

Be Careful in Diagnosis

Mental Status tests are evidence for cognitive dysfunction, not necessarily diagnosis or etiology.

Need to carefully consider testing context: amount of sleep, alcohol, medications, effort level of pt, attitude of pt toward you

MS testing tells you whether you should refer for further assessment (Medical, NeuroPsych, Neurology).

Unless severe deficits are evident, do not use MS testing to make dementia diagnosis for DMV purpose. It is not a tool for estate planning!

MoCA: Montreal Cognitive Assessment

Free of charge

Designed to separate normals from MCI and dementia

10 minutes

30 points; 26+ = normal

Limitations: No studies on ethnicity and education effects

Best substitute for MMSE with higher educated patients

http://www.mocatest.org/

MoCA: Forms in 15 Languages

ArabicCantoneseChineseCzechDutchEnglishFrenchGermanGreekHebrewItalianKoreanPortugueseSpanishThai

MoCA: Forms in 35 Languages

English (Original) |Arabic | Afrikaans | Chinese (Beijing) | Chinese (Cantonese)

| Chinese (Changsha)

| Chinese (Hong Kong) | Chinese (Taiwan) | Czech| Croatian | Danish | Dutch |

Estonian | French

| Finnish | German | Greek | Hebrew | Italian | Japanese | Korean | Persian |

Polish | Portuguese

| Portuguese (Brazil) | Russian | Serbian | Sinhalese | Slovak | Spanish |

Swedish | Thai | Turkish

| Ukrainian | Vietnamese |

MoCA vs. MMSE

MMSE and MOCA

Using a cutoff score of 26:

• MMSE: sensitivity of 18% to detect MCI

• MoCA: sensitivity of 90% to detect MCI

For the mild AD patients, the sensitivity was 78% and

100% respectively.

Specificity excellent for both screening tests (100% and

87% respectively).

Nasreddine, et al., JAGS, 2005

Strategy Recommendation: MMSE & MoCA

Patient presents with cognitive complaints

and functional limits

• Administer Mini-Cog or MMSE 1st

• If MMSE ≥ 26 (normal), administer MoCA

Patient presents with cognitive complaints

and no functional limits:

• Administer MoCA1st

Different Cognitive Domains

Measured by MoCA

Executive functions

Visuoconstructional skills

Language

Memory

Attention and concentration

Calculations

Conceptual thinking, abstraction

Orientation.

MoCA: Montreal Cognitive Assessment

MoCA 1: Executive Processing

Nasreddine ZS, et al., J. Am Geriatr Soc 53:695–699, 2005.

MoCA 2

MoCA 3

The MoCA© may be used without permission for clinical and educational

non-commercial purposes

Alternating Trail Making

"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)]." (Rule: “Number Letter Number Letter”)

Alternating Trail Making

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.

Cube

“Copy this drawing as accurately as you can, in the space below”.

Visoconstructional Skills (Cube)

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.

Draw Clock

Draw a clock. Put in all the numbers and set the time to

10 after 11.

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 center.

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

Wrong!

Correct?

Add NAB Judgment Scale if fail Executive items on MoCA

Executive Dysfunction

Poor decision making capacity (legally incompetent to

make financial, medical, treatment decisions)

Do not learn from negative feedback

Inability to live without supervision

Inability to use psychotherapy

Need behavioral management

Adult Protective Services, Public Guardianship, Need for

Conservatorship

Naming

Beginning on the left, point to each figure and say:

“Tell me the name of this animal”.

Naming

Scoring: One point each is given for the following responses:

(1) camel or dromedary,

(2) lion,

(3) rhinoceros or rhino

Ethnicity: rhino unfamiliar

Word finding difficulty is most common

normal aging deficit

Possible presence of language disorder

(dysphasia, aphasia)

Naming Deficit

Memory Registration

Need to make sure words are actually encoded, therefore

2 repetitions. If cannot do perfect 2nd trial, suspect amnestic

disorder.

“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”.

“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.”

Memory 1

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”.

“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.”

Memory 2

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.

Attention

“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.

Now I am going to say some more numbers, but when I am

through you must repeat them to me in the backwards order.”

Read the three number sequence at a rate of one digit per

second.

Attention 1: Digit Span

Forward Digit Span:

“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:

“Now I am going to say some more numbers, but when I am through you must repeat them to me 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).

Attention 2: Vigilance, Letter A

Vigilance:

“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)

Attention 3: Serial Sevens

“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.

Attention Problems

If Digit Span, Vigilance and Serial Sevens

impaired, consider possible attention

deficit or working memory issue.

30% of normals fail Serial Sevens

Language

“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.”

“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.”

Sentence Repetition

Administration:

“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.”

“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/perfect. 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.).

Verbal Fluency

Administration:

“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 say 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.”

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

Language issues

If repetition and/or fluency impaired,

consider language disorder

Impaired repetition may imply underlying

memory deficit as opposed to language

problem.

Abstraction

Abstraction 1

Administration:

“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.

Abstraction 2

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

traveling, 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.

Poor Abstraction

Consider executive processing deficit.

Verbal abstraction can be normal,

while nonverbal is impaired.

Latter is more important.

Delayed Recall

“I read some words to you earlier, which I asked you

to remember. Tell me as many of those words as

you can remember.”

Delayed Recall 1

Administration:

“I read some words to you earlier, which I

asked you to remember. Tell me as many

of those words as you can remember.”

Scoring: Allocate 1 point for each word

recalled freely without any cues.

Delayed Recall 2: Not 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?”

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 color multiple choice: red, blue, green

Scoring: No points are allocated for words recalled with a cue.

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

Normal vs. Memory Deficit Types

Normal: 4-5 spontaneously recalled

Encoding Failure: poor spontaneous recall and recognition (cueing does not help), i.e. Alzheimer's

Retrieval Failure: Poor spontaneous recall: 1-3 on spont. Recall, normal recognition (cueing helps), i.e. subcorticals (Korsakoff, alcohol abuse, PD, HD, HIV, depression)

Orientation

“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.”

Orientation

Administration:

“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.

Poor Orientation

Most often correlated with amnestic

disorder.

Can reveal confabulation (poor judgment).

Total Score: New rules

Sum all subscores listed on the right-hand side.

Add 2 additional point for an individual who has

4-9 years of formal education, 1 point for 10-12

years of education for a possible maximum of 30

points.

A final total score of 26 and above is considered

normal.

To decrease possible learning effects

when the MoCA is administered

repetitively, four alternative MoCA forms

are in development.

Two versions in English (validation study

completed) will be shortly posted on the

MoCA website, and two French alternate

versions are undergoing validation.

Cautions

Level of effort

Context: Hospital, Clinic, ER

Presence of Psychiatric Disorder

Amount of Sleep, medications

Did they come in voluntarily or were they

brought in with AMS

Executive ↓ more important than Memory↓

MoCA Patterns

Attention and Language most commonly

normal

If language impaired, aphasic?

If attention impaired, delirium?

Poor executive processing and memory

most serious deficits.

MoCA Patterns 2

Beside MoCA score, are there functional

deficits in ability to care for themselves?

• bill paying, memory deficits, medication

noncompliance, etc.

• latter less common in MCI, more common in

dementia of Alzheimer’s type.

Norms

Moca superior to MMSE for MCI detection

MoCA and MMSE

Context of Decision Making Capacity 1

Dissociation of Verbal ability and rest of

cognitive functioning

Information from collateral sources: status

of home (mold, leaking roof), refrigerator,

food, bathroom

Level of cleanness of apartment, mold,

garbage

Method for remembering medications

Presence of paranoia or hallucinations

Context of Decision Making Capacity 2

Evidence of burning pots, not paying bills

Presence, or lack thereof, of supervision

by family members

APS involvement

Executive function level

Anosognosia (denial of deficits): including

toward testing deficits

Dementia: Cognitive ↓, not etiology

WNL: MoCA 28/30, Mem 3/5 +1 cue

58 yo, WNL, Memory 5/5

36 yo, 2 y college

36 yo male, hx alcohol abuse

Hosp: AMS, multifactorial

Encephalopathy: morbid obesity (360),

hypothermia, septic shock,

2 week coma, liver & renal failure

Binges on weekends: 12x 24oz

? Anoxia

Score: 25/30

Memory: 3/5 + 1 cue

Conclusion:

WNL

Alcohol Abuse

59 yo, WNL

59 yo female, BA educ

Mild Stroke 6 y previous

Brief delirium with paranoid

Ideation following abd surgery

Prior MOCA = 23/30 days bef

Cognistat: WNL

Conclusion:

Resolved delirium

Alcoholic Korsakoff Syndrome

Classic profile:

• Normal Cognition

• Amnesia*

•Importance of doing

MS Testing

age 94, with 79 yo gf

Age 94

Therapist: ? Memory

Score: 25/30

Executive 3/5

Memory 2/5 + 1

Recommendation:

Full NP testing

60 yo, schizophrenia, delirium

60 yo female, 1 y college

Schizophrenia, 30 y work

Delirium

Paranoid perceptions

Prior Moca 15/30; Mem 0/5 +4 cue

Score: 15/30

Memory 0/5 + 4 cue

Conclusion: Unresolved delirium

65, H.S. education, CCC referral

Score: 23/30

Executive: 5/5

Memory: 0/5, no cue help

Recommendation:

MCI

Full NP testing

77yo, Overdose or not?

Cognistat: Impaired

Repitition

Block Design

Memory ***

Similarities

Judgment

Conclusion:

Dementia

Supervision of

Medication

71 yo AA male, 2 MAs

71 yo AA male, retired teacher, ESRD

Fell out of bed, trapped

Between dialysis machine & bed

x 2 days; ants; wife downstairs

Prior MoCAs: 16/29; 20/30; Mem 3/5

? Can he do peritoneal dialysis alone

Cognistat:

Comprehension: 2 step only

Block Design: 0/3

Memory: 0/4 +3 cueing

Visual memory: poor

Similarities: 2/4

Conclusion:

MCI

No peritoneal dialysis

56 yo male, post CABG

56 yo male, sp CABG, episode of agitation

req restraints; anx disorder; hx alcohol

abuse; hoarder; odd & eccentric; tax work

Prior MoCA: 23/30; Exec 2/5; Mem 4/5

Current Score: 27/30

Executive: 4/5 (clock)

Fluency: 1/3

Memory: 5/5

Conclusion: Cognition OK;

Psychiatric fu

70 yo, computers, cardiovascular

70 yo male, gifted computer career “genius”

CV hx: CAD with stent, MI, afib, SOB,

fluid in lungs, old CVA, renal insuff, DM

SI, “not worth living”, no plan, irritable

Lives alone

Cognistat:

Memory: 0/4, no cueing help

Judgment: 0/3

Partial MoCA:

OK clock, poor trails

Fluency: 5 in 1 min

Conclusion:

Cognitive Disorder

Needs Assisted Living

72 yo, college educ., APS

Score: 14/30

Executive: 1/5

Memory: 0/5

Conclusion:

Dementia

1st: 41 yo, AIDS

Score: 15/30*

Memory Register: 4x

Executive: 2/5

Memory: 0/5, 2 cue

Conclusion:

Dementia

2nd : AIDS, CD4=40

Score: 3/30**

Executive: 1/5

Memory: 0/5

Conclusion:HIV Dementia

64 yo AA woman, ESRD, dialysis combative

Consult ?: combative during

Dialysis, “I am 64, AA, activist;

I have the right…”

Score: 10/29*

Executive: 2/4

Memory: 2/5, 0 with cue

Conclusion:Personality

Disorder & Dementia

70 yo, HS ESL teacher, Vietnamese

70 yo Vietnamese, BA educ

HS ESL teacher

Cerebellar CVA

Score: 4/20

Motor weakness

Memory: 0/5 + 1 cue

Conclusion:

Vascular Dementia

39 yo, TBI, Anterograde Amnesia

51 yo, dropped off in ED by disappeard wife

51 yo, Phil male, janitor, 6th

grade

Dxs: MS, LF CVA, atrial fib,

vascular

dementia, pseudobulbar,

spastic hemiplegia

Claims: no med ill, no klg

Score: 4/25

Executive: 1/5

Memory 0/5

Conclusions:

Vascular Dementia

Lacks capacity

His Clock

age 33, pregnant, delirium

Hx: pregnant, methadone (for Crohn’s) addiction + prednisone

Score: 22/30*

Executive: 5/5

Memory: 3/5, 5 with cue

Conclusion:

Resolved Delirium

66 yo, pelvic mass is food, not cancer

66 yo female, prior colon CA 2 y ago

Bowel obstruction

Now Pelvic Mass, believes its food,

refuses Tx for CA

Tangential

Long hx of untreated delusional disorder

(NASA, government conspiracy vs. her)

Score: 16/30

Memory: 0/5 – 4 + cueing

Judgment Scale: 7/20

Recommendation:

Delusional Disorder

Cognitive Disorder

Lacks medical capacity

Family supports surgery

Her Clock

57 yo, maggots

57 yo retired IRS auditor, MA educ

Medical noncompliance with wound

Physician aversion: prior amputation

of toe 7 m before, claimed no prior

negative med experience;

Wife:

Sore became maloderous; found

maggots 2 m before; Childhood

cerebral palsy, months in hospital;

cured; Traumatized by toe amputation

Score: 24/30

Executive: 3/5

Memory: 2/5 + 3 cue

Conclusion:

MCI

Full NP testing recom

79 yo MD, intubed

79 yo MD, Parkinsonism

Intubed; written responses

Delirium, Paranoid Prior

? Capacity

Memory 2/5 +3 cue

Conclusion:

Resolved Delirium

Cognitive Disorder

Has Capacity

Full NP testing recom.

His writing: Cognitive = Pretentious

1st : 67 yo male, anticholingeric delirium

Hx: bugs everywhere,

then collapse with balance↓,

SOB, vomiting

Score: 17/30*

Executive: 4/5

Fluency: 2

Memory: 2/5, 2 with cue

Conclusion:

Delirium due to

Increase in Nortriptyline

AC 2nd : 67 yo male, delirium

Hx: Nortrip ↑↑

Score: 24/30*

Executive: 4/5

Fluency: 8

Memory: 5/5

Conclusion:

WNL, resolved delirium

Anticholinergic Syndrome: Mad as a hatter

hot as a hare = high temperature

red as a beet

dry as a bone = decreased mucous, dry

mouth, constipation

blind as a bat = blurred vision

mad as a hatter = hallucinations, delirium

Medications: atrophine, tricyclics, anti-

parkinsonian, antihistamines, haldol, digoxin

54 yo, DM, cardiac arrest, 20 min.

Hx: security guard,

visual halluc. of bees,

visual field cut

Score: 14/30*

Executive: 2/5

Fluency: 4 words

Memory: 0/5, 0 with cue*

Conclusion:

Dementia due to

Anoxic Encephalopathy

His conclusion: “I’m screwed.”

1st : 72 yo M.D., Normal MMSE 2006

2nd : 72 yo M.D., 2007, cautionary tale

Score: 26/30*

Executive: 2/5**

Memory: 4/5

Conclusion:

MCI (Executive ↓)

Follow-up:

NP testing: failed WCST,

Category test

Spent $700,000 in 6 months

Conclusion: Frontotemporal

Dementia

72 yo, MA in history

Score: 12/29*

Executive: 1/5 – Note

Serial Sevens

Memory: 1/5

Conclusion:

Dementia

68 yo male, 12 y educ, executive dissociation

Hx: failure to thrive,

medication non-compliant,

house (horrific odor, garbage,

roof leak, mold everywhere),

denied any problems

Score 14/29*

Memory Register: 4

Executive: 3/5

Memory: 0/5, 1 cue*

NAB Judgment: 16/20

Conclusion:

Dementia

75 yo, male, B& C, combative

Score: 5/30*

Memory Register: 2

Executive: 0/5

Memory: 0/5

NAB Judgment: 10/20

Conclusion:

Dementia

Alcoholism, ESRD, failure to thrive

Score: 12/30*

Executive: ↓↓↓

Attention: ↓↓

Memory: Amnesia (cuing

did not help)

NAB Judgment: 11/20

Conclusion:

Dementia

1st : 62 yo AA woman, TGA?

Sudden AMS at work,

Hotel room supervisor,

5 hours total amnesia,

MRI -, EEG -

Score: 6/30*

Executive: 1/5

Language: ↓

Memory: 0/5 spont.

0/5 Recog*

Orientation: 2/6

Conclusion:

TGA, Dementia?

2nd : 4 days later

2 days later:

MOCA 12/30

(executive & memory)

4 days later:

Cognistat:

Memory: ↓↓

Math: ↓↓

Conclusion:

Cognitive Disorder

(Amnesia)

72 yo woman, no pants

Hx: Earlier RP stroke,

Apt had rotten food, feces

Human services → clerk

2 y ago

Cognistat:

Block Design: ↓↓

Memory: ↓↓

Judgment: ↓↓

Conclusion:

Dementia

87 yo, AA male

Score: 8/30**

Executive: 2/5

Language: ↓↓

Memory: 0/5 spont.

0/5 Recog**

Orientation: 3/6

Conclusion:

Dementia of Alzheimer’s

Type

85 male, failure to thrive, DM

APS, caregiver took over

Apt., “states good memory,

can care for self”

Score: 11/30**

Executive: O/5

Attention: ↓↓

Memory: 0/5 spont.

0/5 Recog.**

NAB Judgment: 6/20

Conclusion:

Dementia of Alzheimer’s Type

85, AMS, episodic delirium, colon CA

MMSE: 17/30*

Score: 10/30

Executive: 0/5

Fluency: ↓↓

Memory: 0/5*

Conclusion:

Dementia of Alzheimer’s

Type

50 yo Male, 20 y Schizophrenia, Suicidal

Executive: 3/5

Similarities: 0/2

Memory: 2/5 +2

Conclusion:

5150d

73 yo, Anxiety

73 yo female, ED, anxiety

Can’t take care of self at home

Lexipro

Sober 4 months

Score: 26/30

Memory 2/5 +1

Recommendation:

Released to son

Full NP recom

70 yo, Master’s degree

Score: 24/30

Memory 0/5

Conclusion

MCI

79, male

Score: 20/30

Executive: 2/5

Attention: ↑↑

Memory: 1/5

Conclusion:

MCI→ Dementia

75 y o, 2 y educ, sound tech

Score: 21/30

Executive: 5/5

Memory 0/5 +2 cue

Conclusion:

MCI

NP testing

77 yo, refuses to leave hospital

77 yo female, hosp SOB, refused

to leave hospital

APS, failure to care for self

5150d grave disability

Prior MoCA = 26/30, Mem 1/5

Recom selling house & assisted

living

3 y college, office work

Names her meds

States can’t care for self

Assessment:

Cognistat WNL (Mem 1/5 +3)

Not psychotic

Fears selling house

Good insight, bad judgment

Needs counseling

83 yo, memory

Cognistat

Memory: 0/4 +2 cue

Comprehension: 1 step only

Similarities: 1 / 4

60 yo schizophrenic in ED

60 yo female, schizophrenic, homeless

“Zen on a Jew…Judaism doesn’t belong

In SF…Muslims trying to kill me”

Score: 16/23

Memory: 1/5 +2 cue

Conclusion:

Shizophrenia

5150d

References

• Holsinger et al. Does this patient have dementia? JAMA, June 6, 2007-Vol 297, No 21;2391-2404.

• Smith T et al. The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Can J Psychiatry. 2007 May;52(5):329-32.

• Zadikoff C. et al. A comparison of MMSE to MoCA in identifying cognitive deficits in Parkinson's disease. Movement Disorders Vol 22, suppl. 16, June 2007.

• Martinić Popović I. et al. Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. Journal of the Neurological Sciences Volume 257, Issues 1-2, 15 June 2007, Pages 185-193.

• Hachinski et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke. 2006 Sep;37(9):2220-41. Epub 2006 Aug 17.

• Gauthier et al. Mild cognitive impairment. Lancet. 2006 Apr 15;367(9518):1262-70. Review.

• J. Reban. Montrealsky kognitivni test /MoCA/: přínos k diagnostice predemencí, Česká Geriatrická Revue 2006 (4):224-229.

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