Montreal Cognitive Assessment (MoCA) Cognitive Screening

Inspection template for administering and scoring the Montreal Cognitive Assessment (MoCA) across attention, memory, language, visuospatial, and executive function domains to screen for mild cognitive impairment.

Assessment Details and Administrator Verification

• Administrator certification verified
  Confirm the administrator is trained and certified/authorized to administer the MoCA.
• Assessment date and time recorded
  Document when the MoCA was administered.
• Assessment setting documented
  Record the location or setting where the assessment was completed.
• Reason for screening documented
  Briefly state the clinical or operational reason for the MoCA screening.
• Participant consent or assent confirmed
  Confirm the participant agreed to proceed with the screening per local policy.
• Language or interpreter needs noted
  Document the language used for administration and any interpreter support or accommodations.

Administration Conditions

• Testing environment free from distraction
  Confirm the participant was assessed in a quiet environment with minimal interruptions.
• Corrective lenses or hearing aids available if normally used
  Confirm the participant had access to usual visual or hearing aids during testing, if applicable.
• Participant alert and able to participate
  Confirm the participant was sufficiently alert and cooperative for valid administration.
• Any testing interruptions documented
  Record any interruptions, fatigue, pain, or other factors that may have affected performance.
• Standard MoCA instructions followed
  Confirm the assessment was administered according to the standardized instructions.

MoCA Domain Scoring

• Visuospatial / executive function score
  Enter the score for visuospatial and executive function tasks.
• Naming score
  Enter the score for naming tasks.
• Attention score
  Enter the score for attention tasks.
• Language score
  Enter the score for language tasks.
• Abstraction score
  Enter the score for abstraction tasks.
• Delayed recall score
  Enter the score for delayed recall tasks.
• Orientation score
  Enter the score for orientation items.

Total Score and Interpretation

• Total MoCA score
  Enter the total MoCA score out of 30.
• Score interpretation
  Select the interpretation based on the total score and clinical context.
• Education adjustment applied
  Indicate whether the standard education adjustment was applied, if applicable.
• Follow-up recommendation documented
  Document any recommended next steps, referral, or repeat assessment plan.
• Results communicated per policy
  Confirm results were communicated according to organizational policy and scope of practice.