| RPT |
.| .| Montreal Cognitive Assessment, Alternate 1| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>|
2-5-8.| <*Answer_5623*>| 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_5624*>| 5D. Serial 7s
starting at 90. Continue for five responses.| <*Answer_5625*>| 6. Language| 6A. Sentence repetition. A bird can fly into closed windows when it's dark and windy.| <*Answer_5626*>| 6B.
Sentence repetition. The caring grandmother sent groceries over a week ago.| <*Answer_5627*>| 7. Words beginning with the letter S.| <*Answer_5628*>| 8. Abstaction| 8A. Similarity between
DIAMOND - RUBY.| <*Answer_5630*>| 8B. Similarity between CANNON - RIFLE.| <*Answer_5643*>| 9. Delayed recall| 9A. Recall TRUCK| <*Answer_5631*>| 9B. Recall BANANA.|
<*Answer_5632*>| 9C. Recall VIOLIN.| <*Answer_5633*>| 9D. Recall DESK.| <*Answer_5634*>| 9E. Recall GREEN.| <*Answer_5635*>| 10. Orientation| 10A. Today's date,|
<*Answer_5636*>| 10B. Current month| <*Answer_5637*>| 10C. Current year| <*Answer_5638*>| 10D. Day of the week| <*Answer_5639*>| 10E. What place is this?| <*Answer_5640*>|
10F. What city are we in?| <*Answer_5641*>| 11. Years of formal education:| <*Answer_5642*>| | 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_5614*>| 2. Rectangle-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
correct.| <*Answer_5615*>| 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_5616*>|
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_5617*>| 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_5618*>| 4. Naming pictured animals| 4A. Giraffe| <*Answer_5619*>| 4B. Bear|
<*Answer_5620*>| 4C. Hippopotamus| <*Answer_5621*>| 5. Attention| 5A. Forward Digit Span.| <*Answer_5622*>| 5B. Backward Digit Span. Correct response for the backwards trial is
|
