Interpretation of MoCA Score of 24 and Recommended Next Steps
A MoCA score of 24 indicates mild cognitive impairment (MCI) and requires further evaluation to determine the underlying cause and appropriate management. 1
Understanding the MoCA Score of 24
The Montreal Cognitive Assessment (MoCA) is a validated screening tool for detecting mild cognitive impairment with scores ranging from 0-30
Traditional cutoff scores:
Age affects interpretation:
- For adults 60-79 years: ≤25 suggests MCI
- For adults 80-89 years: ≤24 suggests MCI
- For adults ≥90 years: ≤23 suggests MCI 3
Education level affects performance:
- Lower education levels may lead to false positives
- Higher education levels may lead to false negatives 1
Recommended Next Steps
1. Rule Out Reversible Causes
- Screen for depression using Geriatric Depression Scale (GDS) - depression can mimic cognitive impairment 1
- Medication review for drugs that can affect cognition 1
- Laboratory testing for:
- Vitamin B12 deficiency
- Hypothyroidism
- Metabolic abnormalities 1
2. Gather Additional Information
- Obtain informant reports on changes in cognition, function, and behavior to increase diagnostic accuracy 1
- Document baseline functional status to help anticipate problems with treatment adherence 1
3. Additional Assessments
- Brain imaging (MRI preferred) to evaluate for:
- Cerebrovascular disease
- Structural abnormalities
- Other potential causes of cognitive impairment 1
- Consider comprehensive neuropsychological evaluation if there are:
- High premorbid functioning
- Cultural/language differences
- Complex medical history 1
4. Follow-up and Monitoring
- Schedule follow-up cognitive assessment in 6-12 months using the same version of the MoCA to track changes over time 1
- Document baseline cognitive status to help anticipate problems with treatment adherence 1
Important Considerations
- Avoid premature diagnosis - a single cognitive test should not be used in isolation for diagnosis of dementia 1
- Test reliability - MoCA has good test-retest reliability (ICC: 0.64-0.82) for monitoring cognitive change over time 4
- Remote testing options - if in-person testing is not possible, telephone versions of MoCA (T-MoCA) are available but require different cutoff scores (approximately 18/22 points suggesting impairment) 5, 6
- Early intervention - early recognition allows for timely intervention and helps families plan for future care needs 1
Advance Planning
- Initiate discussions about advance care planning while cognitive capacity is still preserved:
- Goals of care
- Treatment preferences
- Surrogate decision-makers 1
- Provide education about mild cognitive impairment and risk of progression to dementia 1
Remember that a MoCA score of 24 warrants thorough evaluation but does not alone establish a diagnosis of dementia. The goal is to identify potentially reversible causes and establish appropriate monitoring and management.