Montreal Cognitive Assessment

Montreal Cognitive Assessment (MoCA) Version 8.1

Administration and Scoring Instructions 

The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for 

mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, 

executive functions, memory, language, visuoconstructional skills, conceptual thinking, 

calculations, and orientation. The MoCA may be administered by anyone who understands and 

follows the instructions, however, only a health professional with expertise in the cognitive field 

may interpret the results. Time to administer the MoCA is approximately 10 minutes. The total 

possible score is 30 points; a score of 26 or above is considered normal. 

All instructions may be repeated once.

1. Alternating Trail Making:

Administration: The examiner instructs the subject: "Please draw a line going from a 

number to a letter in ascending order. Begin here [point to (1)] and draw a line from 1 

then to A then to 2 and so on. End here [point to (E)]." 

Scoring: One point is allocated if the subject successfully draws the following pattern: 

1- A- 2- B- 3- C- 4- D- 5- E, without drawing any lines that cross. Any error that is not 

immediately self-corrected (meaning corrected before moving on to the Cube task)

earns a score of 0. A point is not allocated if the subject draws a line to connect the end 

(E) to the beginning (1).

2. Visuoconstructional Skills (Cube):

Administration: The examiner gives the following instructions, pointing to the cube: 

“Copy this drawing as accurately as you can.”

Scoring: One point is allocated for a correctly executed drawing. 

• Drawing must be three-dimensional.

• All lines are drawn.

• All lines meet with little or no space.

• No line is added.

• Lines are relatively parallel and their length is similar (rectangular prisms are 

accepted).

• The cube’s orientation in space must be preserved.

A point is not assigned if any of the above criteria is not met. 

3. Visuoconstructional Skills (Clock):

Administration: The examiner must ensure that the subject does not look at his/her watch 

while performing the task and that no clocks are in sight. The examiner indicates the 

appropriate space and gives the following instructions: “Draw a clock. Put in all the 

numbers and set the time to 10 past 11.”

Scoring: One point is allocated for each of the following three criteria:

• Contour (1 pt.): the clock contour must be drawn (either a circle or a square). Only 

minor distortions are acceptable (e.g., slight imperfection on closing the circle). If the 

numbers are arranged in a circular manner but the contour is not drawn the contour is 

scored as incorrect.

• Numbers (1 pt.): all clock numbers must be present with no additional numbers. 

Numbers must be in the correct order, upright and placed in the approximate quadrants on 

the clock face. Roman numerals are acceptable. The numbers must be arranged in a 

circular manner (even if the contour is a square). All numbers must either be placed inside 

or outside the clock contour. If the subject places some numbers inside the clock contour

and some outside the clock contour, (s)he does not receive a point for Numbers. 

• Hands (1 pt.): there must be two hands jointly indicating the correct time. The hour hand 

must be clearly shorter than the minute hand. Hands must be centered within the clock 

face with their junction close to the clock center. 

4. Naming:

Administration: Beginning on the left, the examiner points to each figure and says: “Tell 

me the name of this animal.”

Scoring: One point is given for each of the following responses: (1) lion (2) rhinoceros or 

rhino (3) camel or dromedary. 

5. Memory:

Administration: The examiner reads a list of five words at a rate of one per second, 

giving the following instructions: “This is a memory test. I am going to read a list of 

words that you will have to remember now and later on. Listen carefully. When I am 

through, tell me as many words as you can remember. It doesn’t matter in what order you 

say them.” The examiner marks a check in the allocated space for each word the subject 

produces on this first trial. The examiner may not correct the subject if (s)he recalls a 

deformed word or a word that sounds like the target word. When the subject indicates 

that (s)he has finished (has recalled all words), or can recall no more words, the examiner 

reads the list a second time with the following instructions: “I am going to read the same 

list for a second time. Try to remember and tell me as many words as you can, including 

words you said the first time.” The examiner puts a check in the allocated space for each 

word the subject recalls on the second trial. At the end of the second trial, the examiner 

informs 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.”

Scoring: No points are given for Trials One and Two. 

6. Attention:

Forward Digit Span: Administration: The examiner gives the following instructions: “I 

am going to say some numbers and when I am through, repeat them to me exactly as I 

said them.” The examiner reads the five number sequence at a rate of one digit per 

second. 

Backward Digit Span: Administration: The examiner gives the following instructions: 

“Now I am going to say some more numbers, but when I am through you must repeat 

them to me in the backward order.” The examiner reads the three number sequence at a 

rate of one digit per second. If the subject repeats the sequence in the forward order, the 

examiner may not ask the subject to repeat the sequence in backward order at this point.

Scoring: One point is allocated for each sequence correctly repeated (N.B.: the correct 

response for the backward trial is 2-4-7). 

Vigilance: Administration: The examiner reads the list of letters at a rate of one per 

second, after giving the following instructions: “I am going to read a sequence of letters. 

Every time I say the letter A, tap your hand once. If I say a different letter, do not tap 

your hand.”

Scoring: One point is allocated if there is zero to one error (an error is a tap on a wrong 

letter or a failure to tap on letter A).

Serial 7s: Administration: The examiner gives the following instructions: “Now, I will 

ask you to count by subtracting 7 from 100, and then, keep subtracting 7 from your 

answer until I tell you to stop.” The subject must perform a mental calculation, therefore, 

(s)he may not use his/her fingers nor a pencil and paper to execute the task. The examiner 

may not repeat the subject’s answers. If the subject asks what her/his last given answer 

was or what number (s)he must subtract from his/her answer, the examiner responds by 

repeating the instructions if not already done so.

Scoring: This item is scored out of 3 points. Give no (0) points for no correct 

subtractions, 1 point for one correct subtraction, 2 points for two or three correct 

subtractions, and 3 points if the subject successfully makes four or five correct 

subtractions. Each subtraction is evaluated independently; that is, if the subject responds 

with an incorrect number but continues to correctly subtract 7 from it, each correct 

subtraction is counted. For example, a subject may respond “92 – 85 – 78 – 71 – 64” 

where the “92” is incorrect, but all subsequent numbers are subtracted correctly. This is 

one error and the task would be given a score of 3. 

7. Sentence repetition:

Administration: The examiner gives the following instructions: “I am going to read you a 

sentence. Repeat it after me, exactly as I say it [pause]: I only know that John is the one 

to help today.” Following the response, say: “Now I am going to read you another 

sentence. Repeat it after me, exactly as I say it [pause]: The cat always hid under the 

couch when dogs were in the room.”

Scoring: One point is allocated for each sentence correctly repeated. Repetitions must be 

exact. Be alert for omissions (e.g., omitting "only"), substitutions/additions (e.g., 

substituting "only" for "always"), grammar errors/altering plurals (e.g. "hides" for "hid"), 

etc.

8. Verbal fluency:

Administration: The examiner gives the following instructions: “Now, I want you to tell 

me as many words as you can think of that begin with the letter F. I will tell you to stop 

after one minute. Proper nouns, numbers, and different forms of a verb are not permitted.

Are you ready? [Pause] [Time for 60 sec.] Stop.” If the subject names two consecutive 

words that begin with another letter of the alphabet, the examiner repeats the target letter 

if the instructions have not yet been repeated.

Scoring: One point is allocated if the subject generates 11 words or more in 60 seconds. 

The examiner records the subject’s responses in the margins or on the back of the test 

sheet.

9. Abstraction:

Administration: The examiner asks the subject to explain what each pair of words has in

common, starting with the example: “I will give you two words and I would like you to 

tell me to what category they belong to [pause]: an orange and a banana.” If the subject 

responds correctly the examiner replies: ‘‘Yes, both items are part of the category 

Fruits.’’ If the subject answers in a concrete manner, the examiner gives one additional 

prompt: “Tell me another category to which these items belong to.” If the subject does 

not give the appropriate response (fruits), the examiner says: “Yes, and they also both 

belong to the category Fruits.” No additional instructions or clarifications are given. 

After the practice trial, the examiner says: “Now, a train and a bicycle.” Following the 

response, the examiner administers the second trial by saying: “Now, a ruler and a 

watch.” A prompt (one for the entire abstraction section) may be given if none was used 

during the example.

Scoring: Only the last two pairs are scored. One point is given for each pair correctly 

answered. The following responses are acceptable: 

- train-bicycle = means of transportation, means of travelling, you take trips in both

- ruler-watch = measuring instruments, used to measure

The following responses are not acceptable: 

- train-bicycle = they have wheels

- ruler-watch = they have numbers

10. Delayed recall: 

Administration: The examiner gives the following instructions: “I read some words to 

you earlier, which I asked you to remember. Tell me as many of those words as you can 

remember.” The examiner makes a check mark (√) for each of the words correctly 

recalled spontaneously without any cues, in the allocated space. 

Scoring: One point is allocated for each word recalled freely without any cues.

11. Orientation: 

Administration: The examiner gives the following instructions: “Tell me today’s date.” If 

the subject does not give a complete answer, the examiner prompts accordingly by 

saying: “Tell me the [year, month, exact date, and day of the week].” Then the examiner 

says: “Now, tell me the name of this place, and which city it is in.”

Scoring: One point is allocated for each item correctly answered. The date and place (name of 

hospital, clinic, office) must be exact. No points are allocated if the subject makes an error of 

one day for the day and date.

TOTAL SCORE: Sum all subscores listed on the right-hand side. Add one point for subject who 

has 12 years or fewer of formal education, for a possible maximum of 30 points. A final total 

score of 26 and above is considered normal.