Ziad Nasreddine & Howard
Chertkow talk with ScienceWatch.com and answer a
few questions about this month's Emerging Research Front
Paper in the field of Social Sciences,
Article: The Montreal cognitive assessment, MoCA: A
brief screening tool for mild cognitive
ZS;Phillips, NA;Bedirian, V;Charbonneau,
S;Whitehead, V;Collin, I;Cummings,
Journal: J AMER GERIAT SOC, 53 (4): 695-699 APR 2005
Addresses: Univ Sherbrooke, Neuro Rivesud Mem Clin, 4896
Taschereau Blvd,Suite 250,Greenfield Pk, Quebec City, PQ
J4V 2J2, Canada.
Univ Sherbrooke, Neuro Rivesud Mem Clin, Quebec City, PQ
J4V 2J2, Canada.
(addresses have been truncated.)
Why do you think your paper is highly
The Montreal Cognitive Assessment (MoCA) was created to respond to the need
for a short but sensitive cognitive screening tool for busy practices.
Clinicians have been using the Mini Mental State Examination (MMSE), which
was published and widely used since 1975. The MMSE, which is a 30-point
cognitive screening test, has very limited sensitivity to detect mild
impairment in cognition since it was developed as a screening measure for
With new treatments emerging to treat Alzheimer's disease (AD), a trend has
emerged to try and capture the earliest signs of cognitive impairment that
could lead to dementia. This very early transition stage to dementia is now
known as Mild Cognitive Impairment (MCI). Many individuals with MCI
progress to AD within four years of their MCI diagnosis, and we perceived
that there was an urgent need for a more sensitive test to detect cognitive
impairment at this stage.
The MoCA test design, user friendliness, and the robust confirmation of its
validity to detect MCI and early AD compared to the MMSE has made this test
very valuable to clinicians around the world, and has also made the
validation study article one of the most-cited in the MCI literature. In
addition, our decision to make the MoCA freely and easily available online
to clinicians, across many languages, has dramatically increased its
utility around the world.
Does it describe a new discovery, methodology, or
synthesis of knowledge?
The MoCA test (Copyright: Z.
Nasreddine, M.D.), was developed from a collection of short cognitive
subtests, that were selected and adapted to evaluate various cognitive
domains rapidly and with high sensitivity to detect subtle cognitive
Would you summarize the significance of your paper in
Our study showed that the MoCA is able to detect 90% of subjects with mild
cognitive impairment compared to only 18% for the more commonly known test,
the MMSE. It is also able to detect 100% of subjects with AD compared to
78% for the MMSE. As most subjects in the MCI stage will convert over time
to AD, the ability of the MoCA to identify subjects with high risk for AD
will enable physicians to monitor them closely and treat them earlier.
How did you become involved in this research and were
any particular problems encountered along the way?
The search for a better cognitive assessment tool began when Ziad S.
Nasreddine, working in a busy community neurology clinic, was pressed for
time and unable to evaluate patients in a timely manner. A quick cognitive
screening tool adapted for a busy practice was clearly needed.
Knowing the limitations of the MMSE in terms of limited sensitivity for
mild cognitive impairment and the restricted scope of cognitive domains
tested, the need was perceived to develop a more comprehensive and
sensitive cognitive screening test, which would be short and adapted to a
busy outpatient clinic. We felt that since we urgently needed such a
screening test, that other clinicians likely had the same needs and would
welcome a well-validated test they could easily use.
Where do you see your research leading in the
The MoCA is now being tested in other neurological diseases such as
Parkinson's disease, multiple sclerosis, and stroke etc., and has proved
very sensitive in detecting mild cognitive impairment in these conditions.
The test will likely be studied in patients with traumatic brain injury,
psychiatric disease, and attention deficit disorders. We are working to
develop multiple forms of the test for repeated use, and computerized
versions of the test may become available. The test may be used to assess
treatment efficacy for various medical and non-medical interventions.
Do you foresee any social or political implications for
Patients in whom we detect early cognitive impairment using the MoCA may be
better protected to prevent injury or liability. The following abilities
would be closely monitored: finance management, medication intake, driving
abilities, and decision-making.
Ziad S. Nasreddine, M.D.
Howard Chertkow, M.D.
Special thanks to all other co-authors of the MoCA validation
study: Natalie A. Phillips, Concordia University, which helped improve
MoCA subtest selection, and analyzed study results. Victor Whitehead,
McGill University, and Isabelle Collin, Sherbrooke University, for their
help in data collection and analysis. Valérie Bédirian, and
Simon Charbonneau, University of Québec in Montreal for their help
in data analysis, and help in MoCA subtest scoring. Jeffrey L. Cummings,
University of California in Los Angeles, for help in MoCA subtest selection
and data analysis.