| RPT |
.| .| Montreal Cognitive Assessment| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>|
response for the backwards trial is 2-4-7.| <*Answer_5549*>| 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_5550*>| 5D. Serial 7s starting at 100. Continue for five responses.| <*Answer_5551*>| 6. Sentence repetition| 6A. I only know that John is the one to help today.|
<*Answer_5552*>| 6B. The cat always hid under the couch when dogs were in the room.| <*Answer_5553*>| 7. Words beginning with the letter F.| <*Answer_5554*>| 8. Abstraction| 8A.
Similarity between TRAIN - BICYCLE.| <*Answer_5555*>| 8B. Similarity between WATCH - RULER.| <*Answer_5556*>| 9. Delayed recall| 9A. Recall FACE| <*Answer_5557*>| 9B.
Recall VELVET.| <*Answer_5558*>| 9C. Recall CHURCH.| <*Answer_5559*>| 9D. Recall DAISY.| <*Answer_5560*>| 9E. Recall RED.| <*Answer_5561*>| 10. Orientation| 10A.
Today's date,| <*Answer_5562*>| 10B. Current month| <*Answer_5563*>| 10C. Current year| <*Answer_5564*>| 10D. Day of the week| <*Answer_5565*>| 10E. What place is
this?| <*Answer_5566*>| 10F. What city are we in?| <*Answer_5567*>| 11. Years of formal education:| <*Answer_5568*>| | Copyright (c) Z. Nasreddine MD| | 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.| $~
DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | MoCA Score: <-MoCA Score->| A score of 26 or greater is considered normal.| | | 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_5540*>| 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_5541*>| 3. Draw a clock.| 3A. Clock face must be a circle with only minor distortion acceptable (e.g., slight imperfection on closing the circle).| <*Answer_5542*>|
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_5543*>| 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_5544*>| 4. Name pictured animals| 4A. Lion| <*Answer_5545*>| 4B.
Rhinoceros or rhino| <*Answer_5546*>| 4C. Camel or dromedary| <*Answer_5547*>| 5. Attention| 5A. Forward Digit Span.| <*Answer_5548*>| 5B. Backward Digit Span. Correct
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