A review comparing different brief assessment tools for cognitive impairment listed the MoCA’s disadvantages as lacking studies in general practice settings, an education bias (12 years), limited use and evidence due to published data being relatively new (2005) and an administration time of over 10min. The MoCA has been found to be superior to the Mini-Mental State Examination (MMSE) as a global assessment tool, particularly in discerning earlier stages of cognitive decline. The MoCA has been validated in many conditions including MCI, Alzheimer’s disease and Parkinson’s Disease dementia. Their average scores were 27.4, 22.1 and 16.2, respect ively. The original study was carried out on 90 controls, 94 patients with MCI and 93 patients with Alzheimer’s Disease. The MoCA is validated for use in 55–85 year olds. Attention, concentration and working memory are evaluated using a sustained attention task (target detection using tapping), a serial subtraction task and digits forward and backward. Visuospatial abilities are assessed using a clock-drawing task and a trail-making task which is said to be useful in assessing fitness to drive. Many of the elements are familiar or similar to other tests of cognitive function. These are Visuospatial/Executive, Naming, Memory, Attention, Language, Abstraction, Delayed Recall and Orientation (to time and place). The MoCA assesses several cognitive domains. A less than satisfactory score would suggest the need for referral to a specialist for further assessment. In my opinion and experience, the MoCA is suitable and very useful as a convenient screening tool for use in the occupational health clinic by occupational health doctors and nurses. The test may be administered by anyone who understands and follows the instructions but the website states that only a health professional with expertise in the cognitive field should interpret the results. MoCA is free for use by universities, foundations, health professionals, hospitals, clinics and public health institutes. A score of 26 or above is considered normal. The assessment consists of a 30 point test on a single side of A4 and can be administered in 10min. A comprehensive website provides the test, instructions, normative data, references, frequently asked questions and permissions and updates. The MoCA may be useful in the occupational health setting for detecting MCI or early dementia especially as the workforce ages. The prevalence of MCI in population-based epidemiological studies ranges from 3 to 19% in adults older than 65 years and more than half progress to dementia within 5 years. MCI is a syndrome defined as cognitive decline greater than expected for an individual’s age and education level but that does not interfere not ably with activities of daily life. The Montreal Cognitive Assessment (MoCA) was developed by Dr Ziad Nasreddine in Montreal, Canada in 1995 for the detection of mild cognitive impairment (MCI) by health professionals.
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