From the Guidelines
A MOCA score of 19/30 indicates mild cognitive impairment or possible early dementia, suggesting significant deficits in one or more cognitive domains and warranting further comprehensive evaluation and medical assessment. This score falls below the normal threshold of 26 or higher on the Montreal Cognitive Assessment, a 30-point screening tool used to detect cognitive dysfunction 1. The MoCA is a widely used and validated instrument for assessing cognitive impairment, and a score of 19 suggests deficits in executive function, memory, attention, language, or visuospatial abilities.
According to the Alzheimer's Association clinical practice guideline, a score of 18 on the MoCA-Blind/Visually Impaired (MoCA-B) has been suggested as a possible indicator of cognitive impairment, which corresponds to a score of approximately 25.5 on the 30-point MoCA 1. However, this requires further validation.
The diagnosis of dementia and cognitive impairment should be based on medical history combined with neuropsychological and other clinical examinations to confirm mental decline 1. Potential causes of cognitive impairment could include Alzheimer's disease, vascular dementia, Parkinson's disease, medication side effects, depression, or other medical conditions.
- The person should be referred to a neurologist or geriatrician for additional testing, including:
- Brain imaging
- Blood tests
- More detailed cognitive assessments
- Early intervention is important, as some causes of cognitive impairment are reversible if treated promptly, while others may benefit from medications that can slow progression 1.
- Family members should also be informed about the results to help provide appropriate support and safety measures.
It is essential to note that while the MoCA is a useful screening tool, it should be used in conjunction with other diagnostic evaluations to determine the underlying cause of cognitive impairment 1.
From the Research
Montreal Cognitive Assessment (MOCA) Score Interpretation
A MOCA score of 19 out of 30 indicates significant cognitive impairment. The following points highlight the implications of such a score:
- A score of 19 is substantially below the traditional cutoff score of 26, which is often used to identify cognitive impairment 2, 3.
- Research suggests that the optimal cutoff score for detecting impairment may be lower, around 20 or 25, depending on the population being studied 3, 4.
- A score of 19 may indicate difficulties in various cognitive domains, such as memory, executive function, attention, language, visuospatial ability, and orientation 5, 6.
- Studies have shown that low MOCA scores are associated with increased risk of cognitive decline, functional impairment, and mortality in various populations, including older adults and individuals with psychotic disorders 4, 6.
Comparison to Other Studies
Other studies have reported similar findings, highlighting the importance of using age- and education-related norms when interpreting MOCA scores 2. The use of a single cutoff score may lead to misdiagnosis of cognitive decline in highly educated or cognitively normal individuals 2, 3.
Domain-Specific Impairment
The MOCA assesses several cognitive domains, and a score of 19 may indicate domain-specific impairment. For example, individuals with amnestic dementia may perform poorly on memory and orientation tasks, while those with aphasic dementia may struggle with language and attention tasks 5.