Maryam Razavi

maryam.razavi@cambio.se

Cambio CDS

To assist clinicians to screen for mild cognitive impairment and Alzheimer's disease.

Use in patients with suspect mild cognitive impairment (MCI). Variables and assigned points: Does patient have more than a 12th grade education? No=1, Yes=0 Visuospatial/executive: - Ask patient to trace the diagram in order: Completed correctly=1, Did not complete correctly=0 - Ask patient to copy cube: Completed correctly=1, Did not complete correctly - Ask patient to draw a clock (ten past eleven): None of the above=0, Correctly drew hands only=1, Correctly drew numbers only=1, Correctly drew contour only=1, Correctly drew two out of three features (i.e., two out of contour, numbers, and hands)=2, Correctly drew all features (i.e., contour, numbers, and hands)=3 Correctly drew all features (i.e., contour, numbers, and hands): - Ask patient to name the first animal: Did not name lion=0, Named lion=1 - Ask patient to name the second animal: Did not name rhinoceros, Named rhinoceros=1 - Ask patient to name the third animal: Did not name camel=0, Named camel=1 Memory: - Read "Face", "Velvet", "Church", "Daisy", "Red", and ask patient to repeat (do two trials and a recall later in exam): Did not complete both trials correctly, Completed both trials correctly Attention: - Read list of digits (2, 1, 8, 5, 4) at 1 digit/sec and ask patient to repeat them in the forward order: Did not repeat correctly=0, Repeated correctly=1 - Read list of digits (7, 4, 2) at 1 digit/sec and ask patient to repeat them in the backward order: Did not repeat correctly=0, Repeated correctly=1 - Read list of letters and ask patient to tap with their hand at each letter A: FBAC MNAA JKLB AFAK DEAA AJAM OFAAB: ≥2 errors=0, <2 errors=1 - Ask patient to do five serial 7 subtractions starting at 100; patient should say 93, 86, 79, 72, 65: 0 correct=0, 1 correct=1, 2 or 3 correct=2, 4 or 5 correct=3 Language: - Read and ask patient to repeat: "I only know that John is the one to help today: Did not repeat correctly=0, Repeated correctly=1 - Read and ask patient to repeat: "The cat always hid under the couch when dogs were in the room": Did not repeat correctly=0, Repeated correctly=1 - Ask patient to name maximum number of words in 1 minute that begin with the letter F: Named <11 words=0, Named ≥11 words=1 Abstraction: - Ask patient similarity between train and bicycle (e.g. both are modes of transportation): Answered correctly=1, Did not answer correctly=0 - Ask patient similarity between watch and ruler (e.g. both are measuring tools): Answered correctly=1, Did not answer correctly=0 Delayed recall: - Ask patient to recall the words with no cue from the memory test previously conducted ("Face", "Velvet", "Church", "Daisy", "Red"): Did not recall any words=0, Recalled 1 words=1, Recalled 2 words=2, Recalled 3 words=3, Recalled 4 words=4, Recalled all words=5 Orientation: - Ask patient the date, month, year, day, place, and city: None correct=0, 1 correct=1, 2 correct=2, 3 correct=3, 4 correct=4, 5 correct=5, All correct=6 Formula: Addition of selected points Interpretation: MoCA Score <26 points is 90% sensitive for mild cognitive impairment and 100% sensitive for Alzheimer’s disease.

1. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. doi: 10.1111/j.1532-5415.2005.53221.x. Erratum in: J Am Geriatr Soc. 2019 Sep;67(9):1991. PMID: 15817019. 2. Freitas S, Simões MR, Alves L, Vicente M, Santana I. Montreal Cognitive Assessment (MoCA): validation study for vascular dementia. J Int Neuropsychol Soc. 2012 Nov;18(6):1031-40. doi: 10.1017/S135561771200077X. Epub 2012 Jun 8. PMID: 22676901. 3. Freitas S, Simões MR, Alves L, Duro D, Santana I. Montreal Cognitive Assessment (MoCA): validation study for frontotemporal dementia. J Geriatr Psychiatry Neurol. 2012 Sep;25(3):146-54. doi: 10.1177/0891988712455235. Epub 2012 Aug 1. PMID: 22859702. 4. Freitas S, Simões MR, Alves L, Santana I. Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Dis Assoc Disord. 2013 Jan-Mar;27(1):37-43. doi: 10.1097/WAD.0b013e3182420bfe. PMID: 22193353. 5. Webb AJ, Pendlebury ST, Li L, Simoni M, Lovett N, Mehta Z, Rothwell PM. Validation of the Montreal cognitive assessment versus mini-mental state examination against hypertension and hypertensive arteriopathy after transient ischemic attack or minor stroke. Stroke. 2014 Nov;45(11):3337-42. doi: 10.1161/STROKEAHA.114.006309. Epub 2014 Sep 23. PMID: 25248911; PMCID: PMC4964908.

OBSERVATION.moca.v0, EVALUATION.moca_assessment.v0