/ Psychological Tests / Cognitive Screening

Montreal Cognitive Assessment (MoCA)

Portuguese version

Simões, M. R., Freitas, S., Santana, I., Firmino, H., Martins, C., Nasreddine, Z., & Vilar, M. (2008). Montreal Cognitive Assessment (MoCA): Manual - Versão final portuguesa [MoCA: Manual – final version]. Serviço de Avaliação Psicológica, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra.

Original version

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. American Geriatrics Society, 53(4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x

Background and description

The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument specifically developed to assess milder forms of cognitive impairment, allowing the global cognitive state to be ascertained rapidly. This screening test has been shown to be a very sensitive tool for this purpose, not only in the spectrum of Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD) (Freitas, Simões, Alves, & Santana, 2013) but also for cognitive impairment associated with many other clinical conditions (e.g. vascular cognitive impairment, Parkinson’s Disease, Huntington’s Disease, and tumors; see studies in http://www.mocatest.org).

These results, which are consistently good as a measure of global cognitive function, have led to the widespread use of the MoCA in both clinical and research contexts. Its extensive validation, international recognition and recommendation in various guidelines make it a useful brief cognitive screening tool (Arnold et al., 2007; Gauthier et al., 2011; Hachinski et al., 2006). In Portugal the MoCA is recommended by the “Direcção Geral de Saúde” and the “Liga Portuguesa Contra a Epilepsia, as a screening test to be used.

Assessment Domain: Brief assessment of cognitive impairment.

Type of Instrument: Paper-and-pencil test, including oral and performance tasks.

Application: Individual, 10-15 minutes.

Population: ≥ 25 years old (Adults).

Dimensions

The MoCA is a screening instrument which allows a global cognitive measurement to be made through the assessment of a wide range of cognitive functions, such as (i) short-term memory, (ii) executive functions, (iii) visuospatial abilities, (iv) language, (v) attention, concentration and working memory, and (vi) temporal and spatial orientation (Nasreddine et al., 2005).

Studies

The first study with the Portuguese experimental version of MoCA was carried out by Mónica Martins, in 2007, through a master's thesis Montreal Cognitive Assessment (MoCA): Validation Studies in groups with Mild Cognitive Impairment and Dementia. The sample for this study was collected at the Psychiatry Service of the Hospitals of the University of Coimbra. This experimental version of MoCA had the collaboration of Dr. Horácio Firmino (psychiatrist) who coordinated authorization for use in Portugal of MoCA with Dr. Ziad S. Nasreddine, author of this cognitive screening instrument. After the translation and adaptation studies (Freitas, Simões, Martins, Vilar & Santana, 2010), as well as the normative study of the MoCA for the Portuguese population (Freitas, Simões, Alves & Santana, 2011), our research group has been conducting various validation studies. Some of these studies further emphasize the psychometric characteristics of the instrument: Influence of sociodemographic variables (Freitas, Simões, Alves & Santana, 2012); Construct validity (Freitas, Simões, Marôco, Alves & Santana, 2012); Item Response Theory - Rasch Model (Freitas, Prieto, Simões, & Santana, 2014) and Partial Credit Model (Freitas, Prieto, Simões, & Santana, 2015), while others studies mainly focus on specific clinical groups: MCI and AD (Freitas et al., 2013); Frontotemporal dementia (Freitas, Simões, Alves, Duro & Santana, 2012); Vascular dementia (Freitas, Simões, Alves, Vicente & Santana, 2012); Multiple Sclerosis (Freitas, Batista, Afonso, Simões, de Sousa, Cunha, & Santana, 2018).

The studies of the MoCA for the Portuguese population supported by the Fundação para a Ciência e Tecnologia (Portuguese Foundation for Science and Technology; SFRH/BD/38019/2007 and SFRH/BPD/91942/2012, both to Sandra Freitas) and by the Fundação Calouste Gulbenkian (Calouste Gulbenkian Foundation) through the project "Memória, avaliação funcional e qualidade de vida: Estudos de validade e normas para a população portuguesa" (Memory, functional assessment and quality of life: Validation studies and norms for the Portuguese population; Proc. 74569, SDH-22 Neurosciences, 2010, PI, Mário R. Simões)

Future research

The systematic research plan of the MoCA for the Portuguese population continues through several ongoing studies, namely: (i) the longitudinal study with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) patients; (ii) the correlation study with biomarkers of AD; (iii) clinical validation for Epilepsy and (iv) clinical validation for Acquired Immunodeficiency Syndrome (AIDS).

Contacts

Sandra Freitas (sandrafreitas0209@gmail.com)

Mário R. Simões (simoesmr@fpce.uc.pt)

References

  1. Bernardes, C., Lima, M., Duro, D., Silva-Spínola, A., Durães, J., Tábuas-Pereira, M., Baldeiras, I., Freitas, S., & Santana, I. (2023). Montreal Cognitive Assessment in Mild Cognitive Impairment: Relationship with Cerebrospinal Fluid Biomarkers and Conversion to Dementia. Journal of Alzheimer’s Disease, 96(3),1173-1182. https://doi.org/10.3233/JAD-230916
  2. Freitas, S. (2011). Envelhecimento e défice cognitivo: Estudos de adaptação, validação e normalização do Montreal Cognitive Assessment (MoCA) [Aging and cognitive impairment: Montreal Cognitive Assessment (MoCA) adaptation, validation and normative studies; PhD Thesis]. Dissertação de Doutoramento, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Coimbra, Portugal. Publicado como e-book no repositório da Universidade de Coimbra.
  3. Freitas, S., Batista, S., Afonso, A. C., Simões, M. R., de Sousa, L., Cunha, L. & Santana, I. (2018). Montreal Cognitive Assessment (MoCA) as a screening test for cognitive dysfunction in Multiple Sclerosis. Applied Neuropsychology: Adults, 25(1), 57-70. https://doi.org/10.1080/23279095.2016.1243108
  4. Freitas, S., Prieto, G., Simões, M.R., & Santana, I. (2014). Psychometric properties of the Montreal Cognitive Assessment (MoCA): An analysis using the Rasch model. The Clinical Neuropsychologist, 28(1), 65-83. https://doi.org/10.1080/13854046.2013.870231
  5. Freitas, S., Prieto, G., Simões, M.R., & Santana, I. (2015). Scaling cognitive domains of the Montreal Cognitive Assessment (MoCA): An analysis using the Partial Credit Model. Archives of Clinical Neuropsychology, 30(5), 435-447. https://doi.org/10.1093/arclin/acv027
  6. Freitas, S., Simões, M. R., Alves, L., Duro. D., & Santana, I. (2012a). Montreal Cognitive Assessment (MoCA): Validation Study for Frontotemporal Dementia. Journal of Geriatric Psychiatry and Neurology, 25(3), 146-154. https://doi.org/10.1177/0891988712455235
  7. 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), 989-996. https://doi.org/10.1080/13803395.2011.589374
  8. Freitas, S., Simões, M. R., Alves, L., & Santana, I. (2012). Montreal Cognitive Assessment (MoCA): Influence of sociodemographic and health variables. Archives of Clinical Neuropsychology, 27, 165-175. https://doi.org/10.1093/arclin/acr116
  9. Freitas, S., Simões, M. R., Alves, L., & Santana, I. (2013). Montreal Cognitive Assessment (MoCA): Validation Study for Mild Cognitive Impairment and Alzheimer’s Disease. Alzheimer Disease and Associated Disorders, 27(1), 37-43. https://doi.org/10.1097/WAD.0b013e3182420bfe
  10. Freitas, S., Simões, M. R., Alves, L., & Santana, I. (2015). Montreal Cognitive Assessment (MoCA). In M. R. Simões, I. Santana & Grupo de Estudos de Envelhecimento Cerebral e Demência (GEECD) (Eds.), Escalas e testes na demência (3ª ed., Vol.1, pp.24-31) [Scales and tests in dementia]. Novartis.
  11. Freitas, S., Simões, M. R., Alves, L., Vicente, M., & Santana, I. (2012). Montreal Cognitive Assessment (MoCA): Validation Study for Vascular Dementia. Journal of International Neuropsychology Society, 18(6), 1031-1040. https://doi.org/10.1017/S135561771200077X
  12. 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, 242-250. https://doi.org/10.1017/S1355617711001573
  13. Freitas, S., Simões, M. R., Martins, C., Vilar, M., & Santana, I. (2010). Estudos de adaptação do Montreal Cognitive Assessment (MoCA) para a população portuguesa [Montreal Cognitive Assessment (MoCA): Portuguese adaptation studies]. Avaliação Psicológica, 9(3), 345-357.
  14. Freitas, S., Simões, M. R., & Santana, I. (2014). Montreal Cognitive Assessment (MoCA): Pontos de corte no Défice Cognitivo Ligeiro, Doença de Alzheimer, Demência Frontotemporal e Demência Vascular [Montreal Cognitive Assessment (MoCA): Cut-off points in Mild Cognitive Impairment, Alzheimer Disease, Frontotemporal Dementia and Vascular Dementia]. Sinapse, 14(1), 18-30.
  15. Freitas, S., Simões, M. R., & Santana I. (2014). Estudos de adaptação, validação e normalização do Montreal Cognitive Assessment (MoCA) para a população portuguesa [Montreal Cognitive Assessment (MoCA): Portuguese adaptation, validation and normative studies]. In L. S. Almeida, M. R. Simões & M. M. Gonçalves (Eds.), Instrumentos e contextos de avaliação psicológica (1ª ed., Vol. II, pp.251-282) [Instruments and contexts of psychological assessment]. Coimbra: Almedina Edições.
  16. Gonçalves, J., Gerardo, B., Nogueira, J., Afonso, R. M., & Freitas, S. (2023). Montreal Cognitive Assessment (MoCA): an update normative study for the portuguese population. Applied Neuropsychology: Adult, 1-7. https://doi.org/10.1080/23279095.2023.2252949
  17. Martins, M. S. S. (2007). Montreal Cognitive Assessment (MoCA): Estudos de Validação Estudos em grupos com Défice Cognitivo Ligeiro e Demência. 2007. Mestrado em Psicologia Clínica e da Saúde, sub-especialização em Psicogerontologia Clínica.
  18. 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. American Geriatrics Society, 53(4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
  19. Pereira, V. L, Freitas, S., Simões, M. R., & Gerardo, B. (2023). Montreal Cognitive Assessment (MoCA): A validation study among prisoners. Criminal Behaviour and Mental Health. https://doi.org/10.1002/cbm.2306
  20. Simões, M. R., Freitas, S., Santana, I., Firmino, H., Martins, C., Nasreddine, Z., & Vilar, M. (2008). Montreal Cognitive Assessment (MoCA): Manual - Versão final portuguesa [MoCA: Manual – final version]. Serviço de Avaliação Psicológica, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra.
  21. Xu, X., Freitas, S., Santana, I., Simões, M. R., Mok, V. C. T., & Chen, C- L.-H. (2023). NINDS-CSN Neuropsychological Battery and Montreal Cognitive Assessment (MoCA). In Gregory J. Boyle (Ed.), The SAGE Handbook of Clinical Neuropsychology: Clinical Neuropsychological Assessment and Diagnosis (Vol. 2. pp. 581-597). Sage.