Dear Colleagues,

I hope you are doing well in the midst of this important Covid-19 Pandemic.

We have received a lot of requests to use a remote version of the MoCA to assess patients’ cognition for clinical or research purposes. Here are a few options that have been validated to use for remote testing:

Abbreviated Telephone Versions

1. MoCA without the visual elements, scored out of 22. Cut-off: N ≥ 19. You can download the Blind version of the MoCA from our website and administer it over the phone. Pendlebury et al. Stroke. 2013; 44:227-229

2. Mini/5min MoCA Hong Kong version. 30 points. Wong et al. Stroke. 2015; 46(4): 1059-1064.

3. Mini/5min MoCA, Montreal version. 15 points. Cut-off: N ≥ 11. Nasreddine et al. Validated but not yet published. Test and Instructions are now available on the website as well as the initial validation results comparing the 5 min version to the full version.

Full MoCA via Audio-Visual Conference

Full version can be administered via Skype, FaceTime, or Teleconference, or any locally approved platform.

The rater proceeds as follows:

Identify yourself, from which clinic/institution and in which city you are located.

Tell the subject the purpose of your call, obtain their verbal consent to proceed and instruct them to get a white sheet of paper, a pencil and an eraser, and to isolate themselves in a quiet room. The rater shows the patient the visual section of the MoCA – See below (First 8 points)

Trails: Show them the Trail and say: “Please tell me where the arrow should go next to respect the pattern I am showing you”

Cube: Show them the cube and say: “Copy the cube”

Clock: “Draw a clock. Put in all the numbers and set the time to 10 past 11.”

“Please fold the paper in half and set it and your pencil off to the side” (Or alternate instructions if using a provided folder: “Please place your paper and pencil in the provided folder and place it off to the side”)

Animal naming: “Tell me the name of these animals.”

The rest of the test is done the same way as in the clinic except for Vigilance(letter fluency) and Orientation:

Letter fluency: “I am going to read a sequence of letters. Every time I say the letter A, tap with pencil/pen on the side of the phone. If I say a different letter, do not tap.”

Date: “Look straight at the camera and tell me today’s date, day of the week, month and year”

Place: “What Clinic/Institution am I calling you from?”

City: “What is the city in which our Clinic/Institution is located?”

REFERENCES:

Comparing face-to-face and videoconference completion of the Montreal Cognitive Assessment (MoCA) in community-based survivors of stroke.
Chapman JE, Cadilhac DA, Gardner B, Ponsford J, Bhalla R, Stolwyk RJ.
J Telemed Telecare. 2019 Dec 9:1357633X19890788.

A Validation Study of the Remotely Administered Montreal Cognitive Assessment Tool in the Elderly Japanese Population.
Iiboshi K, Yoshida K, Yamaoka Y, Eguchi Y, Sato D, Kishimoto M, Funaki K, Mimura M, Kishimoto T.
Telemed J E Health. 2019 Nov 19. doi: 10.1089/tmj.2019.0134.

A feasibility study of conducting the Montreal Cognitive Assessment remotely in individuals with movement disorders
A Abdolahi, MT Bull, KC Darwin… – Health informatics …, 2016 – journals.sagepub.com
Health Informatics J. 2016 Jun;22(2):304-11. doi: 10.1177/1460458214556373. Epub 2014 Nov 11.

The reliability of the Montreal Cognitive Assessment using telehealth in a rural setting with veterans
Nathaniel DeYoung, Brian V Shenal
First Published January 10, 2018

Gerontologist. 2017 Oct; 57(5): e85–e93.
Published online 2017 Feb 3.
Dementia Care Comes Home: Patient and Caregiver Assessment via Telemedicine
Allison Lindauer, et al

Mandatory MoCA training and certification

The date of September 1st 2020 to complete your training will be revised and will be announced later.

Stay safe,

Ziad Nasreddine MD, Neurologist

MoCA Copyright Owner

Director of MoCA Clinic and Institute