Skip to main content

Montreal Cognitive Assessment (MoCA): Validation Study for Vascular Dementia

  • Sandra Freitas (a1) (a2), Mário R. Simões (a1) (a2), Lara Alves (a1), Margarida Vicente (a1) and Isabel Santana (a3)...

The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the MMSE. The aim of the present study was to validate the MoCA as well as its short version, which was proposed by the NINDS-CSN VCI Harmonization Standards for screening Vascular Dementia (VaD) patients. The results, based on a homogeneous sample of 34 VaD patients, indicate that the MoCA is a psychometrically valid and reliable instrument for cognitive screening in VaD patients, showing excellent discriminant validity. Both the full and short versions of the MoCA had excellent diagnostic accuracy in discriminating VaD patients, exhibiting an area under curve (AUC) higher than the MMSE [AUC(MoCA full version) = .950; 95% IC = .868–.988; AUC(MoCA short version) = .936; 95% IC = .849–.981; AUC(MMSE) = .860; 95% IC = .754–.932]. With a cutoff below 17 on the MoCA full version and 8 on the short version, the results for sensitivity, specificity, positive and negative predictive values, and classification accuracy were superior compared to the MMSE. In conclusion, both versions of the MoCA are valid, reliable, sensitive and accurate screening instruments for VaD patients. (JINS, 2012, 18, 1–10)

Corresponding author
Correspondence and reprint requests to: Sandra Freitas, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802 Coimbra, Portugal. E-mail:
Hide All
Aggarwal, A., Kean, E. (2010). Comparison of the Folstein Mini Mental State Examination (MMSE) to the Montreal Cognitive Assessment (MoCA) as a cognitive screening tool in an inpatient rehabilitation setting. Neuroscience & Medicine, 1, 3942.
Alves, L., Simões, M. R., Martins, C. (2009). Teste de Leitura de Palavras Irregulares (TeLPI) [Reading Word Irregular Test]. Coimbra, Portugal: Serviço de Avaliação Psicológica da Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra [Psychological Assessment Department, Faculty of Psychology and Educational Sciences, University of Coimbra].
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. – Text Revised). Washington, DC: American Psychiatric Association Press.
Braaten, A.J., Parsons, T.D., McCue, R., Sellers, A., Burns, W.J. (2006). Neurocognitive differential diagnosis of dementing diseases: Alzheimer's disease, vascular dementia, frontotemporal dementia, and major depressive disorder. International Journal of Neuroscience, 116, 12711293.
Canadian Study of Health and Aging Working Group. (1994). Canadian study of health and aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150(6), 899913.
Cumming, T.B., Bernhardt, J., Linden, T. (2011). The Montreal Cognitive Assessment: Short cognitive evaluation in a large stroke trial. Stroke, 42, 26422644. doi:10.1161/STROKEAHA.111.619486
Desmond, D.W. (2004). Vascular dementia. Clinical Neuroscience Research, 3, 437448.
Dong, Y., Sharma, V.K., Chan, B.P., Venketasubramanian, N., Teoh, H.L., Seet, R.C., Chen, C. (2010). The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. Journal of the Neurological Sciences, 299(1-2), 1518.
Folstein, M., Folstein, S., McHugh, P. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189198.
Freitas, S., Santana, I., Simões, M.R. (2010). The sensitivity of the MoCA and MMSE to cognitive decline: A longitudinal study. Alzheimer's & Dementia, 6(4), S353S354.
Freitas, S., Simões, M.R., Alves, L., Duro, D., Santana, I. (2012). Montreal Cognitive Assessment (MoCA): Validation study for Frontotemporal Dementia. Journal of Geriatric Psychiatry and Neurology, in press.
Freitas, S., Simões, M.R., Alves, L., Santana, I. (2011). Montreal Cognitive Assessment (MoCA): Normative study for the Portuguese population. Journal of Clinical and Experimental Neuropsychology, 33(9), 989996.
Freitas, S., Simões, M. R., Alves, L., Santana, I. (2012). Montreal Cognitive Assessment (MoCA): Validation study for Mild Cognitive Impairment and Alzheimer's disease. Alzheimer Disease and Associated Disorders, doi:10.1097/WAD.0b013e3182420bfe
Freitas, S., Simões, M.R., Marôco, J., Alves, L., Santana, I. (2012). Construct validity of the Montreal Cognitive Assessment (MoCA). Journal of International Neuropsychology Society, 18, 19.
Garrett, K.D., Paul, R.H., Libon, D.J., Cohen, R.A. (2004). Defining the diagnosis of vascular dementia. Applied Neuropsychology, 11(4), 202207.
Gauthier, S., Patterson, C., Gordon, M., Soucy, J., Schubert, F., Leuzy, A. (2011). Commentary on “Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. ”: A Canadian perspective. Alzheimer's & Dementia,, 7, 330332.
Guerreiro, M. (1998). Contributo da Neuropsicologia para o estudo das demências [Contribution of Neuropsychology to the study of dementia] (Unpublished doctoral dissertation). University of Lisbon, Lisbon.
Hachinski, V., Bowler, J.V. (1993). Vascular dementia. Neurology, 43, 21592160.
Hachinski, V., Iadecola, C., Petersen, R.C., Breteler, M.M., Nyenhuis, D.L., Black, S.E., Leblanc, G.G. (2006). National Institute of Neurological Disorders and Stroke – Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards. Stroke, 37, 22202241.
Hachinski, V., Iliff, L.D., Zihlka, E., Du Boulay, G.H., McAllister, V.L., Marshall, J., Symon, L. (1975). Cerebral blood flow in dementia. Archives of Neurology, 32, 632637.
Hachinski, V., Lassen, J., Marshall, J. (1974). Multi-infarct dementia: A cause of mental deterioration in the elderly. Lancet, 2, 207210.
Hanley, J.A., McNeil, B.J. (1983). A method of comparing the areas under receiver operating characteristic curves. Radiology, 148, 839843.
Hughes, C.P., Berg, L., Danziger, W.L., Coben, L.A., Martin, R.L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry, 140, 566572.
Ihara, M., Okamoto, Y., Takahashi, R. (2012). Suitability of the Montreal Cognitive Assessment versus the Mini-Mental State Examination in detecting Vascular Cognitive Impairment. Journal of Stroke and Cerebrovascular Diseases. doi:10.1016/j.jstrocecerebrovasdis.2012.01.001 [Epub ahead of print].
Ihl, R., Frölich, T.D., Martin, E.M., Maurer, K. (1992). Differential validity of psychometric tests in dementia of Alzheimer type. Psychiatry Research, 44, 93106.
Ikeda, M., Hokoishi, K., Maki, N., Nebu, A., Tachibana, N., Komori, K., Tanable, H. (2001). Increased prevalence of vascular dementia in Japan: A community-based epidemiological study. Neurology, 57, 839844.
Ismail, Z., Rajji, T.K., Shulman, K.I. (2009). Brief cognitive screening instruments: An update. International Journal of Geriatric Psychiatry, 25(2), 111120. doi:10.1002/gps.2306
Jacova, C., Kertesz, A., Blair, M., Fisk, J.D., Feldman, H.H. (2007). Neuropsychological testing and assessment for dementia. Alzheimer's Dementia, 3(4), 299317. doi:10.1016/j.jalz.2007.07.011
Jorm, A., O'Brien, J. (2004). The epidemiology of vascular dementia: An overview and commentary. In J. O'Brien, D. Ames, L. Gustafson, M. Folstein, & E. Chiu (Eds.), Cerebrovascular disease, cognitive impairment and dementia (2nd ed., pp. 95100). London: Martin Dunitz.
Lamar, M., Price, C.C., Giovannetti, T., Swenson, R., Libon, D.J. (2010). The dysexecutive syndrome associated with ischaemic vascular disease and related subcortical neuropathology: A Boston process approach. Behavioural Neurology, 22, 5362. doi:10.3233/BEN-2009-0237
Lobo, A., Launer, L.J., Fratiglioni, L., Andersen, K., Di Carlo, A., Breteler, M.M., Hofman, A. (2000). Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurology, 54(Suppl. 5), S4S9.
Lobo, A., Martinez-Lage, J., Soininen, H., Hofman, A. (2000). Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurology, 54(Suppl. 5), S10S15.
Lonie, J.A., Tierney, K.M., Ebmeier, K.P. (2009). Screening for Mild Cognitive Impairment: A systematic review. International Journal of Geriatric Psychiatry, 24(9), 902915. doi:10.1002/gps.2208
Looi, J.C., Sachdev, P.S. (1999). Differentiation of vascular dementia from AD on neuropsychological tests. Neurology, 53, 670678.
Martinić-Popović, I., Šerić, V., Demarin, V. (2006). Early detection of mild cognitive impairment in patients with cerebrovascular disease. Acta Clinica Croatica, 45, 7785.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939944.
Moorhouse, P., Rockwood, K. (2008). Vascular cognitive impairment: Current concepts and clinical developments. Lancet Neurology, 7, 246255.
Mungas, D., Reed, B.R., Kramer, J.H. (2003). Psychometrically matched measures of global cognition, memory, and executive function for assessment of cognitive decline in older persons. Neuropsychology, 17(3), 380392.
Nasreddine, Z., Phillips, N.A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for Mild Cognitive Impairment. Journal of American Geriatrics Society, 53(4), 695699.
O'Brien, J., Reisberg, B., Erkinjuntti, T. (2003). Vascular burden of the brain. International Psychogeriatrics, 15(1), 710.
Pendlebury, S.T., Cuthbertson, F.C., Welch, S.J., Mehta, Z., Rothwell, P.M. (2010). Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: A population-based study. Stroke, 41, 12901293.
Pirscoveanu, D., Tudorica, V., Matcau, L., Zaharia, C., Matcau, D., Ene, L. (2009). Six months follow-up study on cognitive performances in patients with ischemic vascular events. Timisoara Medical, 59(1), 8185.
Reed, B.R., Mungas, D.M., Kramer, J.H., Betz, B.P., Ellis, W., Vinters, H.V., Chui, H.C. (2004). Clinical and neuropsychological features in autopsy-defined vascular dementia. The Clinical Neuropsychologist, 18(1), 6374.
Román, G.C. (2003). Vascular dementia: Distinguishing characteristics, treatment, and prevention. Journal of American Geriatrics Society, 51, S296S304.
Román, G.C., Royall, D.R. (1999). Executive control function: A rational basis for the diagnosis of vascular dementia. Alzheimer's Disease & Associated Disorders, 13(Suppl. 3), S69S80.
Román, G.C., Tatemichi, T.K., Erkinjuntti, T., Cummings, J.L., Masdeu, J.C., Garcia, J.H., Scheinberg, P. (1993). Vascular dementia: Diagnostic criteria for research studies–Report of the NINDS-AIREN International Workshop. Neurology, 43, 250260.
Rosen, W.G., Mohs, R.C., Davis, K.L. (1984). A new rating scale for Alzheimer's Disease. American Journal of Psychiatry, 141, 13561364.
Santana, I. (2006). Demência Vascular [Vascular dementia]. In H. Firmino (Ed.), Psicogeriatria [Psychogeriatry] (pp. 413426). Lisbon: Psiquiatria Clínica.
Schmand, B., Jonker, C., Hooijer, C., Lindeboom, J. (1996). Subjective memory complaints may announce dementia. Neurology, 46(1), 121125.
Simões, M. R., Freitas, S., Santana, I., Firmino, H., Martins, C., Nasreddine, Z., Vilar, M. (2008). Montreal Cognitive Assessment (MoCA): Versão portuguesa [Montreal Cognitive Assessment (MoCA): Portuguese version]. Coimbra, Portugal: Serviço de Avaliação Psicológica da Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra [Psychological Assessment Department, Faculty of Psychology and Educational Sciences, University of Coimbra].
Tombaugh, T.N., McIntyre, N.J. (1992). The Mini-Mental State Examination: A comprehensive review. Journal of American Geriatrics Society, 40, 922935.
Ueda, K., Kawano, H., Hasuo, Y., Fujishima, M. (1992). Prevalence and etiology of dementia in a Japanese community. Stroke, 23, 789803.
van Straaten, E.C., Scheltens, P., Knol, D.L., van Buchem, M.A., van Dijk, E.J., Hofman, P.A., Barkhof, F. (2003). Operational definitions for the NINDS-AIREN criteria for Vascular dementia. Stroke, 34, 19071912.
Wind, A.W., Schellevis, F.G., van Staveren, G., Scholten, R.P., Jonker, C., van Eijk, J.T. (1997). Limitations of the Mini-Mental State Examination in diagnosing dementia in general practice. International Journal of Geriatric Psychiatry, 12, 101108.
Wong, A., Kwan, P., Chan, A., Lam, W., Nyenhuis, D., Nasreddine, Z., Wong, L. (2008). The validity, reliability and utility of the Cantonese Montreal Cognitive Assessment (MoCA) in Chinese patients with confluent white matter lesions. Hong Kong Medical Journal, 14(6), FP1.
Wong, A., Xiong, Y.Y., Kwan, P.W., Chan, A.Y., Lam, W.W., Wang, K., Mok, V.C. (2009). The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dementia and Geriatric Cognitive Disorders, 28, 8187.
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M., Leirer, V.O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 3749.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed