Reviewing the Research: Is the MoCA Test Reliable?

The Montreal Cognitive Assessment (MoCA) is a 30-point cognitive screening test in which a score of 26 or higher is considered normal. It is reliable for flagging pronounced cognitive impairment, but not on its own: it meets only 3 of the 5 Alzheimer's Association recommendations for effective dementia screening, and a Cochrane review found that over 40% of people without dementia scored below the cutoff.

When it comes to treating cognitive impairment, early intervention is essential for delaying the onset of Alzheimer's disease and other forms of dementia. Not only does this improve patient and caregiver quality of life, but it also reduces the cost of care: spending on Alzheimer's and other dementias surpassed $277 billion in 2018, according to an Alzheimer's Association report, one factor that makes early diagnosis of dementia essential.

The MoCA remains one of the most widely used dementia screening tools in clinical practice, but its accuracy limitations mean it is rarely enough by itself. In this article, we compare the MoCA against the Alzheimer's Association recommendations for effective dementia screening and discuss the advantages of digital alternatives for cognitive screens.

Is the MoCA test reliable for detecting cognitive impairment?

The Montreal Cognitive Assessment was developed by Dr. Ziad Nasreddine in 1995 for the detection of mild cognitive impairment (MCI) in clinical practice. Since then, it has become one of the most widely used cognitive screening tools among healthcare professionals in hospitals, neurology practices, and primary care settings.

Currently available in over 30 languages, the MoCA can be completed in under 10 minutes. However, it does require a trained professional to accurately interpret results. While it cannot provide a formal diagnosis of MCI or dementia, it is often used as an initial screening tool to detect cognitive deficits.

Scoring uses that 30-point scale, and the 26-point threshold is the standard marker for normal cognition. A high score requires high functioning in multiple cognitive domains that may be impaired in dementia patients, including the following:

• Memory
• Executive functioning
• Attention
• Language
• Visuospatial
• Orientation

While the MoCA has been used to accurately flag signs of advanced cognitive dysfunction, it requires follow-up testing after use to determine if dementia is present and what type of dementia a patient may be exhibiting signs of.

What limits MoCA accuracy?

The Montreal Cognitive Assessment can be effective for identifying signs of pronounced cognitive impairment, but it lacks specificity and may not pick up on earlier, subtler signs of MCI. A Cochrane review found that while the MoCA was able to correctly identify over 94% of people with dementia, it also recorded a high number of false positives. In fact, over 40% of people without dementia scored under 26 points and would have been falsely flagged for dementia if their provider had used the MoCA alone.

These limitations may be related to the MoCA's susceptibility to:

• Ethnocultural, linguistic, and education-based biases: In one study based in an urban setting, the MoCA cut points were found to be inadequate in a culturally diverse population, even when including the Spanish-language MoCA.
• Inability to account for comorbid mental health conditions: Conditions like depression, which are frequently comorbid with dementia, can affect cognitive performance. Tests like the MoCA cannot distinguish if impairment is due to dementia or a comorbidity.
• Impaired vision and/or hearing: Results of a cognitive function test may be inaccurate or skewed if visual or auditory disabilities challenge the patient's capacity to execute the test.

Does the MoCA meet Alzheimer's Association recommendations?

When we compare the MoCA to the Alzheimer's Association's recommendations, the assessment meets only 3 out of 5 of the organization's criteria for an effective cognitive screening tool.

While the MoCA is commonly used in primary care settings, is correctly used as a screener for further testing, and outperforms the Mini-Mental State Examination on the criteria the Alzheimer's Association lists, the test does not meet some of the other requirements. For instance, the test:

• Is not able to be administered in under 5 minutes
• Is not free of educational, language, and/or cultural bias

As with any brief initial screener for cognitive decline, the Montreal Cognitive Assessment does not have the capacity to accurately diagnose dementia on its own. If a patient fails a cognitive function test, this may be an indication that further evaluation or a specialist referral is warranted.

Should you use the MoCA or digital cognitive testing?

On its own, the MoCA may not have the diagnostic capabilities or detail to give a full look at cognitive function. Initial assessments are a key step in clinical practice for flagging symptoms of cognitive dysfunction, allowing providers to confidently refer patients for further neurocognitive testing.

In an overtaxed system, avoiding unnecessary referrals saves time and money for patients and providers. That's where digital screening testing tools come in. Combining the MoCA with digital cognitive screens is a powerful way to gather the data providers need to deliver quality care.

Advantages of digital cognitive screening

Compared to traditional pen-and-paper screens like the MoCA, digital cognitive assessments carry several advantages:

• Virtual or in-clinic administration: Enabling enhanced accessibility standards so that patients residing in remote locations or with mobility concerns can still receive high-quality care.
• Reduced cultural, linguistic, and educational bias: Some digital, nonverbal, visual assessments rely less on language and education level, making results more comparable across diverse populations.
• Faster administration and scoring: Tests are automatically scored, and reports are directly integrated into electronic health records (EHRs), leaving more time for providers to focus on delivering personalized medical care.
• Higher retesting value: Monitoring objective changes to cognitive function can more precisely detect decline from a personal baseline or track the effectiveness of treatment longitudinally with test items that are randomly generated at each administration.

Research suggests that evidence of dementia-related cognitive dysfunction can be detected up to 9 years in advance. Accurate digital tools can catch subtle symptoms that tools like the MoCA test may not, while also minimizing false positives, allowing for the earliest possible intervention for the right patients.

Creyos: A digital assessment for mild to severe cognitive impairment

The Creyos Dementia Assessment is a scientifically validated, digital testing battery designed to support early dementia detection and ongoing monitoring in clinical practice. It simplifies screening practices while also providing objective, detailed insight into patient cognition.

Our dementia protocol includes three key components:

Online cognitive tasks

Brief, gamified online cognitive tasks measure cognitive domains that have been shown to be associated with dementia and affected by mild cognitive impairment. The two-task screener can be completed in under five minutes either remotely or in person and is scored instantly to determine if further testing is required.

Signs of cognitive impairment can be initially assessed using a two-task screener. The screener portion of the assessment is most similar to the MoCA and can be administered on its own or as part of a more comprehensive assessment that includes four additional cognitive tasks to provide more detailed information about cognition. These tasks assess:

• Episodic memory
• Visuospatial working memory
• Attention
• Verbal short-term memory
• Mental rotation
• Response inhibition

By analyzing performance across multiple cognitive domains, the assessment can help clinicians distinguish normal aging patterns from MCI or dementia. This improves its diagnostic assistance compared to brief screening tools like the MoCA alone.

Behavioral and mental health questionnaires

In addition to objective cognitive tasks, the Creyos assessment includes standardized questionnaires that capture subjective patient information. These data help clinicians put results in context or identify comorbidities that may be influencing cognitive function.

Included questionnaires assess the following:

• Subjective cognitive complaints (IQCODE)
• Instrumental activities of daily living (IADL)
• Depression symptoms (PHQ-9)
• Anxiety symptoms (GAD-7)

Care planning and ongoing monitoring tools

Creyos extends beyond assessment with built-in tools that can use results as part of clear, actionable, and personalized care plans.

Key care planning features include the following:

• Pre-packaged cognitive care plans tailored to individual profiles
• Task-level retesting for monitoring progression or treatment response
• Automated reports that integrate directly into EHR systems

This streamlined approach reduces administrative burden while enabling ongoing tracking of cognitive impairment over time. Creyos also supports documentation needs related to the CMS-HCC V28 Medicare Advantage risk adjustment system, allowing both your patients and practice to thrive.

MoCA vs. Creyos: Alzheimer's Association recommendations compared

Measured against recommendations from the Alzheimer's Association, here is how the MoCA and the Creyos Dementia Protocol compare across the five criteria:

Backed by hundreds of studies and large-scale research trials, plus real-world use in neurology and primary care settings, Creyos delivers scalable testing with high accuracy for modern dementia care.

Managing cognitive decline in global aging populations

As dementia prevalence continues to rise worldwide, healthcare providers need practical ways to adapt and better support patients experiencing cognitive dysfunction. Cognitive screening is evolving, and the shift away from tools like the Montreal Cognitive Assessment toward more detailed digital screening and assessment tools is a positive step forward.

By normalizing and simplifying cognitive assessment, providers can stay ahead of dementia care, benefiting patients, families, and clinical teams alike.

Get Started Using the Creyos Dementia Assessment and Care Plan

Speak to our product and reimbursement experts to learn how you can integrate the Creyos Dementia Screener, Assessment, and Care Plan into your clinic workflows for greater efficiency and patient outcomes.

Reviewed by Mike Battista, Director of Science & Research at Creyos

Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.