Questions about the Montreal Cognitive Assessment

Palmetto Peg

My husband was tested at our local memory clinic by a MOCA Certified Rater.  She administered the Montreal Cognitive Assessment (MoCA).  His score was 24.  My questions are these:  Does it show a different kind of problem depending on where he scored lower?  For instance, in the Visuospatial/Executive section, he scored 5 out of 5.  He drew the clock, the cube, and could following the numbers to letters.

On the naming section, he got the lion and rhinoceros, but called a camel a giraffe, and got 2 out of 3.  On the memory section the first time through, there are no points given, but of the 5 words given on the first trial he got four, and on the second trial he got three.  In the delayed recall, when asked those same words, he only got 1 out of 5.  On the language section he could only repeat one of the two sentences.  

He counted backward by 7's okay, and his orientation as to date, month,  year, day, place and city were okay.

His score was one point less than his score when he took this test 6 months ago.  

Am I making a big leap if I think this shows his main problem his short term memory?  He remembers basically nothing I tell him during the day and asks the same things over and over.

Finally, what does a score of 24 really mean?  From what I could see online, it means that he has cognitive difficulties, but are they more like AD, or something else?  

I know there are a lot of questions here, but any help you can give me would be wonderful.  We keep getting cancelled for our neurologist appointment due to COVID, and I am trying to better understand what is happening.  Thanks so much in advance!

Michael Ellenbogen

AAll of this is just a baseline to see the changes. It can be better the next time as it can vary based on many issues.

Palmetto Peg

Thanks, Michael.  I thought it might differ based on your educational background - for instance an accountant would do better on the number things.  I guess I need to be patient and let this play out.  I appreciate your reply!

June45

Palmetto Peg wrote:

I thought it might differ based on your educational background - for instance an accountant would do better on the number things.

Peg, you might be on to something there.  My husband did abysmally on most of the test, except as a mechanical engineer, he drew the picture of a chair perfectly, angles and all.

loveskitties

You mention that his score was one point lower than the previous test.  Do you know how the tests relate on the specific area...math on test 1 vs math on test 2 type of compare?

It might give you a better view of areas of change.

Palmetto Peg

That is a great question, LoveKitties.  He scored poorly in the memory section with the 5 words on both tests, but got one word after 5 minutes the first time but didn't get any this time.  Last time he couldn't do the clock, but he got the camel correct. He could only repeat one of the sentences both times.  Really just a shift with the clock the animals and one less word remembered after 5 minutes.

Palmetto Peg

I think it would make a difference what they had studied and worked in all of their adult life.  They also give back 1 point on the test for people who did not finish high school.  I assume that means there is some part of additional education translating into a better score.

wizmo

MoCA is a rough snapshot of multiple possible areas of deficit and can be used to measure relative changes over time.  It is not much of a diagnostic tool.  Detailed diagnosis would come from multiple other tests.  A full neuropsych evaluation should take 1-2 hours and administer a battery of different tests.  Imaging with MRI/PET scans also would be more revealing as to which parts of the brain are involved.

Over 4+ years I have watched my DW's MoCA score decline gradually from 24 to 12 and it's heartbreaking each time she fails in a new area.

Palmetto Peg

I would love to get him into a neurologist.  We now have an appointment for January, after having our appointment cancelled due to Covid concerns.  He had an MRI, but according to the PCP, it really just ruled out strokes and vascular dementia.  I am learning that the medical wheels turn very slowly, as most of you already know!  Thanks for the information!

Michael Ellenbogen

I use to do drafting and now I can not even do something 3 dimensional to copy a drawing I see in front of me. That started about 3 years ago as I was good before that. So it does not matter what you did.

harshedbuzz

Palmetto Peg-

I think it's important to remember that MoCA is a screening rather than an instrument for diagnostic evaluation. A score 26 or above is considered normal. 

My dad did fairly well on these sorts of tests well into the disease process. I happened to sit in on the last appointment he had that included MoCA about 6-9 months before he died from complications of aspiration pneumonia.

For dad, I think part of it was cognitive reserve. He was good with numbers and had a dual undergraduate degree in math- he could do serial subtraction by 7s a bit more quickly than I could and he blew my mother out of the water. That said, he'd previously had remarkable spatial reasoning skills but these were lost early on. He could draw the cube well enough, but IRL he couldn't understand why I couldn't get all three cars in their one-car garage. He completely blew the delayed recall with prompts- one of those was a "rose" (which happened to be his mother's name)- I was gobsmacked that he didn't recall it.

This talks a bit about scoring-

March 2002 (va.gov)

HB

Rescue mom

Just as another example, my DH with Alzheimer’s doesn’t remember his kids, where he lives, what a sandwich is, anything he’s been told 30 seconds later. No concept of time, can’t dress himself. Etc etc. But, like the mechanical engineer, he can copy most any drawing perfectly.