75 (75)    MH REPORT (601.93)

Name Value
REPORT NUMBER 75
INSTRUMENT MOCA
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