NAME :
Education :
Sex :

MONTREAL COGNITIVE ASSESSMENT (MOCA)
VISUOSPATIAL / EXECUTIVE

Copy
cube

Date of birth :
DATE :

Draw CLOCK (Ten past eleven)

POINTS

( 3 points )

A

E
End

5

2

B

1
Begin

4

D

3

C
[

]

[

]

[

]

[

Contour

]

[

Numbers

]

__/5

Hands

NAMING

[ ]
MEMORY

ATTENTION

[ ] __/3

[ ]

Read list of words, subject
must repeat them. Do 2 trials.
Do a recall after 5 minutes.

Read list of digits (1 digit/ sec.).

FACE

VELVET

CHURCH

DAISY

RED

No
points

1st trial
2nd trial

[ ] 2 1 8 5 4
[ ] 7 4 2

__/2

[ ] FBACMNAAJKLBAFAKDEAAAJAMOFAAB

__/1

Subject has to repeat them in the forward order
Subject has to repeat them in the backward order

Read list of letters. The subject must tap with his hand at each letter A. No points if ≥ 2 errors

[ ] 93

Serial 7 subtraction starting at 100

[ ] 86

[ ] 79

[ ] 72

[ ] 65

__/3

4 or 5 correct subtractions: 3 pts, 2 or 3 correct: 2 pts, 1 correct: 1 pt, 0 correct: 0 pt

LANGUAGE

Repeat : I only know that John is the one to help today. [ ]
The cat always hid under the couch when dogs were in the room. [ ]

[

Fluency / Name maximum number of words in one minute that begin with the letter F

ABSTRACTION

Similarity between e.g. banana - orange = fruit

DELAYED RECALL

Has to recall words
WITH NO CUE

Optional

ORIENTATION

__/2
__/1

] _____ (N ≥ 11 words)

[ ] train – bicycle [ ] watch - ruler

__/2
__/5

FACE

VELVET

CHURCH

DAISY

RED

[ ]

[ ]

[ ]

[ ]

[ ]

Points for
UNCUED
recall only

Category cue
Multiple choice cue

[ ] Date

[ ] Month

© Z.Nasreddine MD Version November 7, 2004

www.mocatest.org

[ ] Year

[ ] Day

[ ] Place

Normal ≥ 26 / 30

[ ] City

TOTAL

__/6
__/30

Add 1 point if ≤ 12 yr edu