The Montreal Cognitive Assessment (MoCA) is the most widely used dementia screening test in the world
In fact, it’s the test former US President Donald Trump famously bragged about ‘aceing’ as part of his cognitive health check in 2018.
The test however, has some limitations, relying on the test-taker having good hearing and vision to complete the exercises.
But with more than half of Australians aged between 60 and 70 experiencing hearing loss, and more than 400 000 people over 65 being vision impaired, misdiagnosis of dementia is a real risk.
That was until associate professor Piers Dawes, deputy director of Macquarie University’s Centre for Ageing, Cognition and Wellbeing, together with colleagues and MoCA developers in Montreal, created two new versions of the assessment.
“We worked to develop alternative parallel versions of the MoCA, a version for people with hearing impairment that’s entirely visually administered and a version for people with vision impairment that’s entirely spoken,” he explains.
Dawes says the original MoCA is a short 15-minute screening test which is freely available.
“It involves asking a person a few puzzle-type questions, they have to draw a picture of a three-dimensional box, they have to draw a clock and put the hands on the clock at the correct time, they have to recognise pictures of a camel and a lion.
“They’re read a list of words which they have to remember and repeat back at the end of the test, things like that,” he explains.
“It’s very good at distinguishing people who have dementia, from people who have mild cognitive impairment or people that have normal cognition.”
However, studies show that simulating the effects of hearing or vision impairment can have a significant impact on an individual’s performance on the test.
“You can imagine actually, the symptoms of sensory impairment can look a bit similar to the symptoms of a cognitive impairment – the person is not quite well oriented, they’re always asking for repetition, they’re not sure what’s going on,” Dawes says.
“It can look like the person has a cognitive impairment when actually they just have a hearing or vision problem.”
Dawes also says that psychologists and mental health experts don’t always routinely assess a patient’s hearing and vision status and take that into account during their formal dementia assessment.
MoCA-HI for people with hearing impairment has been widely tested across Europe and Australia, is validated and available for use on the MoCA website.
Data collection for MoCA-VI has been interrupted by the COVID-19 pandemic, but Dawes hopes it will also be available by the end of this year.
“I’m hopeful that these tests will be very widely used in the future and I’m aware that these tests are already being translated into other languages, which is fantastic,” he says.