If you have noticed your loved one struggling with complex tasks, getting lost in familiar places, or repeating themselves, a visit to a primary care doctor is the vital first step.
In the past, doctors relied on the Mini-Mental Status Exam (MMSE); today, the Montreal Cognitive Assessment (MoCA) is widely regarded as the superior tool for early detection.
Why the MoCA is Better Than the MMSE
The main reason the MoCA has become the preferred choice is its ability to catch Mild Cognitive Impairment (MCI) before it progresses to full-blown dementia.
- Sensitivity: Research shows the MoCA has 90%-100% sensitivity for detecting early impairment, whereas the MMSE often misses these subtle changes, catching only about 18% of MCI cases.
- Executive Function: The MoCA assesses higher-level brain functions such as planning and organization, which are often the first to decline in early Alzheimer’s disease or vascular dementia.
- 2025 Guidelines: Current clinical practice guidelines now explicitly recommend the MoCA over the MMSE for routine screening.
How the MoCA Test Works
The MoCA is a one-page, 30-point test that takes about 10–15 minutes. It can be administered on paper, via a tablet app, or even through a telehealth video call.
The MoCA dementia test evaluates 9 key cognitive domains:
- Visuospatial/Executive: Includes drawing a clock set to a specific time and copying a 3D cube.
- Naming: Identifying animals (like a lion, rhinoceros, or camel).
- Memory: Recalling a list of five words after a delay.
- Attention: Tapping a hand when hearing a specific letter.
- Language: Repeating complex sentences and naming as many words as possible starting with a specific letter (e.g., “F”).
- Abstraction: Finding the similarity between two items (e.g., “How are a train and a bicycle alike?”).
- Delayed Recall: Re-testing the five words from earlier.
- Orientation: Stating the exact date, month, year, and current city.
- Education Adjustment: If the person has 12 years or fewer of formal education, one point is added to their total to ensure fairness.
Understanding the MoCA Scores
| Score Range | What it Usually Indicates |
|---|---|
| 26 – 30 | Normal cognitive function |
| 18 – 25 | Mild Cognitive Impairment (MCI) |
| 10 – 17 | Moderate impairment |
| Below 10 | Severe impairment |
Note: If the individual has 12 years or fewer of formal education, one point is added to their total score for accuracy.
Important Note: To ensure accuracy, the MoCA official site now requires that healthcare professionals be trained and certified to administer and score the test.
Next Steps After the MoCA Dementia Test
If the score indicates impairment, don’t panic. The MoCA is a screening tool, not a final diagnosis. Many treatable conditions, such as vitamin B12 deficiency, sleep apnea, and UTIs, can cause low scores.
Ask the doctor for:
- A Full Blood Panel: To rule out physical causes.
- Neuropsychological Testing: For a more in-depth look at brain function.
- Imaging: such as MRI to identify physical changes in the brain.
How are the MoCA and MMSE different?
The MoCA is similar to the MMSE, but it assesses a broader range of cognitive functions, whereas the MMSE focuses primarily on memory and recall.
The MoCA is generally better at detecting mild impairment and early Alzheimer’s disease because it’s a more sensitive test and is more challenging.
If a doctor sees a patient who is questioning their mental functioning, they might administer the MoCA test.
But if a patient comes in and is clearly cognitively impaired, a very sensitive test wouldn’t be as necessary since the issues are more obvious.
The MoCA has also been shown to be a better screening tool for conditions like:
- Parkinson’s disease
- Vascular dementia
- Traumatic brain injury (often from falls)
- Huntington’s disease
- Brain tumors
- Multiple sclerosis
How are the MoCA and MMSE similar?
Although these are useful screening tools for cognitive impairments, neither test was designed to diagnose mental conditions.
They’re both initial screening tests that are used to determine whether further cognitive testing is needed.
They also can’t be used to distinguish between conditions.
For example, you couldn’t use either test to diagnose someone with Alzheimer’s disease versus frontotemporal dementia. After the initial screening, more testing would be needed.
Recommended for you:
- SAGE Test: 15 Minute At-Home Test for Alzheimer’s
- The Mini-Mental Status Exam: A Dementia Screening Tool
- Testing for Dementia: Why the Mini-Mental Status Exam Isn’t Enough for Diagnosis
About the Author
Connie is the founder of DailyCaring.com and was a hands-on caregiver for her grandmother for 20 years. (Grandma made it to 101 years old!) She knows how challenging, overwhelming, and all-consuming caring for an older adult can be. She also understands the importance of support, especially in the form of practical solutions, valuable resources, and self-care tips.
I wanted to see a copy of the MOCA test.
In the article above, there are a couple of links to the MoCA website, which has the test. Here’s a direct link – https://www.mocatest.org/
the MOCA Does need training to have diagnostic accuracy . You need to revise your advice on this test. Please check with the authors of this test.
This website is otherwise excellent and i recommend it to all my caregivers who face issues. Do please adjust your stance on the MOCA .
Thanks very much for alerting us to this change! We’ve now updated the article to remove that statement. (We had been using older information from the MoCA site, which has since been updated.)
What does a score of 23 mean on this test? Alzheimers????
No, it absolutely does not mean that someone has Alzheimer’s or dementia.
This is a screening test only and MUST be interpreted by a doctor. It does not diagnose anything. What the score means is that someone needs to be evaluated for any potential cognitive issues. There are many TREATABLE health conditions that could cause these types of symptoms, which is why it’s so important to see a doctor and find out the true cause of the issue. Even something as simple and easily treatable as a urinary tract infection can cause alarming cognitive changes.
Here’s more information about a variety of treatable health conditions that could cause temporary cognitive impairment:
— Is It Alzheimer’s or a Urinary Tract Infection? https://dailycaring.com/alzheimers-or-urinary-tract-infection/
— 7 Treatable Health Conditions with Symptoms Similar to Dementia https://dailycaring.com/7-treatable-health-conditions-with-symptoms-similar-to-dementia/
— 8 Treatable Diseases That Mimic Dementia https://dailycaring.com/8-treatable-diseases-that-mimic-dementia/
Here’s information about what needs to happen in order to get an accurate diagnosis of Alzheimer’s or dementia — How Is Dementia Diagnosed? A Geriatrician Explains https://dailycaring.com/how-is-dementia-diagnosed-a-geriatrician-explains/