|Montreal Cognitive Assessment - Blind (MOCA BLIND) (MOCA BLIND)
| Gender: <.Patient_Gender.>
|
| MOCA BLIND Total Score = <-Total->
| A score of 19 or greater is considered normal.
|
|Questions and Answers:
|
| 1A. Forward Digit Span.
| <*Answer_9494*>
| 1B. Backward Digit Span. Correct response for the backwards trial
|
| is 7-4-2.
| <*Answer_9495*>
| 1C. 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_9496*>
| 1D. Serial 7 subtraction starting at 100. Continue for five responses
| <*Answer_9497*>
| 2A. Sentence repetition. I only know that John is the one to help today.
| <*Answer_9498*>
| 2B. Sentence repetition. That cat always hid under the couch when dogs
| Date Given: <.Date_Given.>
| were in the room.
| <*Answer_9499*>
| 3. Words beginning with the letter F.
| <*Answer_9500*>
| 4A. Similarity between TRAIN - BICYCLE.
| <*Answer_9501*>
| 4B. Similarity between WATCH - RULER.
| <*Answer_9502*>
| 5A. Recall FACE.
| <*Answer_9503*>
| Clinician: <.Staff_Ordered_By.>
| 5B. Recall VELVET.
| <*Answer_9504*>
| 5C. Recall CHURCH
| <*Answer_9505*>
| 5D. Recall DAISY.
| <*Answer_9506*>
| 5E. Recall RED.
| <*Answer_9507*>
| 6A. Today's date.
| <*Answer_9508*>
| Location: <.Location.>
| 6B. Current month
| <*Answer_9509*>
| 6C. Current year
| <*Answer_9510*>
| 6D. Day of the week
| <*Answer_9511*>
| 6E. What place is this?
| <*Answer_9512*>
| 6F. What city are we in?
| <*Answer_9513*>
|
| 7. Years of formal education:
| <*Answer_9514*>
|
|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
| Veteran: <.Patient_Name_Last_First.>
| SSN: <.Patient_SSN.>
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
|
