If a patient comes in and is clearly functionally impaired, there’s no need for that highly sensitive test.” So if a physician has a patient come in with minimal complaints and questions whether it’s affected him or her functionally, the physician would likely choose the MoCA. “It’s the more sensitive of the two and also more difficult. “For mild impairment, the MoCA is the better test,” says Abhay Moghekar, MBBS, an assistant professor of neurology at The Johns Hopkins University School of Medicine in Baltimore.

Their varying degrees of sensitivity create the biggest difference and likely become the biggest factor for determining which one is used. “Patients with only minor cognitive impairment may be overlooked if this is the principal screening tool used.” “That’s certainly fine as a composite measure over time, but the MMSE is relatively insensitive to mild disease,” says Roy Hamilton, MD, MS, an assistant professor of neurology at the University of Pennsylvania in Philadelphia. More pressed for time, an internist or a primary care physician would likely conduct only one-probably the MMSE-which would be periodically repeated to test for potential decline. Many memory clinics and neurologists administer both tests as well as a host of others. Neither test is very detail oriented and both would likely be used only for initial screening. The MoCA takes approximately 10 to 12 minutes. They are both brief, though the MMSE is a little shorter, taking about seven to eight minutes to administer. Similar But Differentīoth the MMSE and the MoCA are routine cognitive screening tests rated on a 30-point scale. Physicians say caretakers and other professionals can help put their patients at ease by stressing that these tests are only meant to help. Like any test, especially those assessing cognitive abilities, the thought of participating can make older adults anxious. Lessig’s study found that the MoCA is more sensitive to subtle cognitive deficits in patients with Parkinson’s disease compared with the MMSE, though the MMSE is the more commonly used test. For instance, the MMSE has a heavy language component, but that’s not an area that tends to be as much a deficit of conditions like Parkinson’s or other forms of dementia, so that’s where the MoCA comes in at being a little more sensitive.” It seems to be a little better at looking in depth at some of the deficits that the MMSE might not pick up. “The MoCA has since gone on to be used for other diseases as well. “The MoCA is newer to the scene and originally just looked at patients with milder forms of Alzheimer’s,” explains Stephanie Lessig, MD, an assistant clinical professor at UCSD Neurosciences and VA Medical Center, who was lead author on a comparative study examining the use of the MoCA vs. Assessing many of the same areas as the MMSE, the MoCA is a little more in depth and includes tasks such as a clock-drawing test and a trail test (connecting the dots). Today, the Montreal Cognitive Assessment (MoCA), a newer test created in 1996, is also available. Created by renowned psychiatrist Marshal Folstein, MD, and introduced in 1975, the MMSE tests cognitive function by examining orientation, word recall, language abilities, attention and calculation, and visuospatial ability. In the past, testing for Alzheimer’s disease and other cognitive issues often meant turning to the Mini-Mental State Exam (MMSE) before any further testing was undertaken.

Trail making requires cognitive flexibility generated through the dorsolateral and medial prefrontal cortices.The Montreal Cognitive Assessment, used to evaluate cognitive abilities, can better discern some deficits than the Mini-Mental State Exam.At the end of the second trial, inform the subject that (s)he will be asked to recall these words again by saying, “ I will ask you to recall those words again at the end of the test.” Try to remember and tell me as many words as you can, including words you said the first time.” Put a check in the allocated space for each word the subject recalls after the second trial. When the subject indicates that (s)he has finished (has recalled all words), or can recall no more words, read the list a second time with the following instructions: “ I am going to read the same list for a second time. It doesn’t matter in what order you say them.” Mark a check in the allocated space for each word the subject produces on this first trial. When I am through, tell me as many words as you can remember. I am going to read a list of words that you will have to remember now and later on. Read a list of 5 words at a rate of 1 word per second, giving the following instructions: “ This is a memory test.

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