| RPT |
|Montreal Cognitive Assessment Version 8.3 (MOCA_8.3)
| Gender: <.Patient_Gender.>
|
| MOCA_8.3 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_9465*>
| 2. Bed-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_9466*>
| 3A. Clock face must be a circle with only minor distortion acceptable
| (e.g., slight imperfection on closing the circle).
| <*Answer_9467*>
| Date Given: <.Date_Given.>
| 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_9468*>
| 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.
| <*Answer_9469*>
| Clinician: <.Staff_Ordered_By.>
| 4A. Horse, pony, mare or foal
| <*Answer_9470*>
| 4B. Tiger
| <*Answer_9471*>
| 4C. Duck
| <*Answer_9472*>
| 5A. Forward Digit Span.
| <*Answer_9473*>
| 5B. Backward Digit Span. Correct response for the backwards trial is
| 7-4-2.
| Location: <.Location.>
| <*Answer_9474*>
| 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_9475*>
| 5D. Serial 7 subtraction starting at 100. Continue for five responses.
| <*Answer_9476*>
| 6A. Sentence repetition. I only know that John is the one to help today.
| <*Answer_9477*>
| 6B. Sentence repetition. The cat always hid under the couch when the
| dogs were in the room.
|
| <*Answer_9478*>
| 7. Words beginning with the letter F.
| <*Answer_9479*>
| 8A. Similarity between TRAIN - BICYCLE.
| <*Answer_9480*>
| 8B. Similarity between WATCH - RULER.
| <*Answer_9481*>
| 9A. Recall LEG.
| <*Answer_9482*>
| 9B. Recall COTTON.
| Veteran: <.Patient_Name_Last_First.>
| <*Answer_9483*>
| 9C. Recall SCHOOL.
| <*Answer_9484*>
| 9D. Recall TOMATO.
| <*Answer_9485*>
| 9E. Recall WHITE.
| <*Answer_9486*>
| 10A. Today's date.
| <*Answer_9487*>
| 10B. Current month
| SSN: <.Patient_SSN.>
| <*Answer_9488*>
| 10C. Current year
| <*Answer_9489*>
| 10D. Day of the week
| <*Answer_9490*>
| 10E. What place is this?
| <*Answer_9491*>
| 10F. What city are we in?
| <*Answer_9492*>
| 11. Years of formal education:
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
| <*Answer_9493*>
|
|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
|
