| RPT |
|Montreal Cognitive Assessment Version 8.1 (MOCA_8.1)
| Gender: <.Patient_Gender.>
|
| MOCA_8.1 Total Score = <-Total->
| A score of 26 or greater is considered normal.
| Memory Index Score = <-MIS-> / 15
|
|Questions and Answers:
|
| 1. Alternating Trail Making. Correct 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 is scored incorrect.
| <*Answer_9407*>
| 2. Cube-Visuoconstructional Skills. Correct: All must be
| present: three-dimensional, all lines are drawn, no line
| is added, lines are relatively parallel and their length
| is similar.
| <*Answer_9408*>
| 3A. Clock face must be a circle with only minor distortion
| acceptable (e.g., slight imperfection on closing the circle).
| Date Given: <.Date_Given.>
| <*Answer_9409*>
| 3B. All clock numbers must be present with no additional numbers;
| numbers must be in the correct order and placed in the
| approximate quadrants on the clock face; Roman numerals are
| acceptable; numbers can be placed outside the circle contour.
| <*Answer_9410*>
| 3C. 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.
| Clinician: <.Staff_Ordered_By.>
| <*Answer_9411*>
| 4A. Lion
| <*Answer_9412*>
| 4B. Rhinoceros or rhino
| <*Answer_9413*>
| 4C. Camel or dromedary
| <*Answer_9414*>
| 5A. Forward Digit Span.
| <*Answer_9415*>
| 5B. Backward Digit Span. Correct response for the backwards trial
| Location: <.Location.>
| is 7-4-2.
| <*Answer_9416*>
| 5C. Vigilance. Correct when there is zero to one errors (an error is
| a tap on a wrong letter or a failure to tap on letter A).
| <*Answer_9417*>
| 5D. Serial 7 subtraction starting at 100. Continue for five responses
| <*Answer_9418*>
| 6A. Sentence repetition. I only know that John is the one to help today.
| <*Answer_9419*>
| 6B. Sentence repetition. That cat always hid under the couch when dogs
|
| were in the room.
| <*Answer_9420*>
| 7. Words beginning with the letter F.
| <*Answer_9421*>
| 8A. Similarity between TRAIN - BICYCLE.
| <*Answer_9422*>
| 8B. Similarity between WATCH - RULER.
| <*Answer_9423*>
| 9A. Recall FACE.
| <*Answer_9424*>
| Veteran: <.Patient_Name_Last_First.>
| 9B. Recall VELVET.
| <*Answer_9425*>
| 9C. Recall CHURCH
| <*Answer_9426*>
| 9D. Recall DAISY.
| <*Answer_9427*>
| 9E. Recall RED.
| <*Answer_9428*>
| 10A. Today's date.
| <*Answer_9429*>
| SSN: <.Patient_SSN.>
| 10B. Current month
| <*Answer_9430*>
| 10C. Current year
| <*Answer_9431*>
| 10D. Day of the week
| <*Answer_9432*>
| 10E. What place is this?
| <*Answer_9433*>
| 10F. What city are we in?
| <*Answer_9434*>
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
| 11. Years of formal education:
| <*Answer_9435*>
|
|Information contained in this note is based on a self-report assessment
|and is not sufficient to use alone for diagnostic purposes. Assessment
|results should be verified for accuracy and used in conjunction with
|other diagnostic activities and procedures.
||Copyright (c) Z. Nasreddine MD
|
