From the Research
The minimum Montreal Cognitive Assessment (MOCA) score required for driving capabilities is not universally established, but a score of 18 or less should raise concerns about driving safety, as indicated by a study published in the Journal of the American Geriatrics Society in 2015 1. While the MOCA is a useful screening tool for cognitive impairment, with scores below 26 out of 30 suggesting possible cognitive impairment, driving ability requires a complex set of cognitive, physical, and perceptual skills that cannot be fully assessed by a single test score. Driving assessments typically involve comprehensive evaluations including on-road testing, visual processing, reaction time, and executive function assessments. Healthcare providers may use MOCA scores as one component in their evaluation, but decisions about driving capability should be individualized and may involve input from occupational therapists specializing in driving rehabilitation, neuropsychologists, and other specialists. Some key points to consider include:
- The MOCA is a screening tool, not a definitive diagnostic test, and its results should be interpreted in the context of a comprehensive evaluation 2.
- A study published in 2023 found that MOCA cutoffs <23 to <25 maximized the sum of sensitivity and specificity for detecting mild cognitive impairment, but this does not directly translate to driving capability 3.
- The effects of formal education level on MOCA interpretation should also be considered, as individuals with lower education levels may be more likely to be classified as potentially impaired using the standard MOCA cutoff 2. If cognitive impairment is suspected, a referral for a comprehensive driving evaluation is recommended rather than relying solely on a MOCA cutoff score. This approach acknowledges that some individuals with mild cognitive impairment may still drive safely in limited conditions, while others with seemingly minor deficits may have significant driving impairments. For example, a study published in 2009 found that approximately half of patients with Parkinson's disease with a normal MMSE score had cognitive impairment based on their MOCA score, highlighting the importance of using the MOCA as part of a comprehensive evaluation 4. Ultimately, the decision to allow or restrict driving privileges should be based on a thorough assessment of the individual's cognitive, physical, and perceptual abilities, rather than relying solely on a MOCA score.