![]() ![]() The MoCA’s memory testing involves more words, fewer learning trials, and a longer delay before recall (5 min for MoCA vs greater than 10 sec for MMSE). 4 The MoCA provides higher sensitivity and specificity to distinguish between MCI and normal function. Study of the MMSE shows it is poor at the upper end (particularly with an educated client) in discriminating between normal cognitive function and MCI. Using a cutoff score of less than 26 provides sensitivity of 80% and specificity of 91% to distinguish MCI from normal cognitive function. A guide on how to administer the test, the correct answers, and the way to score the responses of each patient is provided. ![]() ![]() The MoCA consists of a series of questions designed to yield a score based on various competencies-visuospatial, executive, naming, memory, attention, language, abstraction, delayed recall, and orientation. The MoCA is one of several tests used by family physicians, neurologists, and gerontologists for assessing patients’ mental acuity. Unfortunately, the patient was not given the option of not driving until successful completion of a road test, and his licence was suspended. The geriatrician had informed him to stop driving immediately and had submitted a Medical Condition Report to the Ministry of Transportation. His wife drove him home from the appointment. Interestingly, the patient’s wife, who also attended the appointment, was surprised not to have been asked about her and her family’s concerns about her husband’s driving. 3 The patient scored 23 out of 30 on the MoCA, and at the end of the 40-minute visit was diagnosed as having sufficient cognitive impairment to be incompetent to operate a motor vehicle. As part of the assessment, the geriatrician performed the Montreal Cognitive Assessment (MoCA). The patient was referred and saw the geriatrician 2 months later. In fact, the patient’s son-in-law was also a neurologist and had commented that he had no concerns about his father-in-law’s current driving ability.Īfter the diagnosis, the patient’s family members contacted the Alzheimer Society’s First Link program they were informed that it would be helpful for him have a local geriatrician, as his neurologist-a cognitive specialist-was some distance away. 2 His Mini-Mental State Examination (MMSE) score had been 27 out of 30, and there had been absolutely no indication of unsafe driving behaviour, accidents, near-misses, traffic tickets, etc. His family had no concerns about the questions from the Driving and Dementia Toolkit. His neurologist appropriately discussed the issue of his driving, and, after inquiring with the family, believed that he was safe to drive. He was told by the neurologist that his symptoms might also be consistent with early Alzheimer dementia and that he would be seeing him every 4 to 6 months for review. An active 69-year-old retired professor was diagnosed with MCI by a cognitive neurologist in the summer of 2009. ![]()
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