MoCA Score Modification for Blind Patients
Direct Answer
Use the MoCA-Blind (MoCA-B) variant, which eliminates the first 4 visually-dependent items and scores out of 22 points instead of 30, with an approximate cutoff of 18/22 (equivalent to 26/30) suggesting cognitive impairment. 1
Understanding the MoCA-B Variant
The MoCA-Blind was specifically designed for patients with visual impairment and removes items requiring visual or motoric components 1:
Eliminated items (accounting for 8 points):
- Mini Trails-B test
- 3-D figure copy
- Clock drawing test
- Naming of 3 animal drawings 1
Scoring range: 0-22 points (instead of 0-30) 1
Suggested cutoff: Approximately 18/22 points indicates possible cognitive impairment, though this requires further validation 1
Administration Protocol
Administer only the verbal response items that do not require visual or motoric components 1:
- Memory tasks (word recall)
- Attention and concentration items
- Language tasks
- Abstraction questions
- Orientation questions 1
The MoCA-B is identical to the Telephone MoCA variant, as both eliminate the same visually-dependent items 1.
Critical Interpretation Considerations
Never interpret the MoCA-B score in isolation - integrate it with comprehensive clinical assessment 2:
- Detailed history from patient and reliable informant
- Functional assessment of activities of daily living
- Complete neurological examination
- Patient's demographic background (age, education, language) 2
Education adjustment remains essential: Patients with less than 4 years of education require special consideration even with the MoCA-B variant, as education level critically affects interpretation 2
Common Pitfalls to Avoid
Do not attempt to "convert" the 22-point score back to a 30-point equivalent beyond the general guideline that 18/22 approximates 26/30 - the proportional conversion (18/22 = 25.5/30) is mentioned but requires validation 1
Do not diagnose cognitive impairment based solely on the MoCA-B score - it is a screening tool requiring comprehensive clinical correlation, not a diagnostic test 2
Do not overlook that the MoCA-B has not been as extensively validated as the standard MoCA - the cutoff of 18/22 is suggested but requires further validation studies 1
Next Steps After Screening
If the MoCA-B suggests impairment (score <18/22), proceed immediately with 2:
- Comprehensive diagnostic workup including formal neuropsychological testing
- Laboratory evaluation for reversible causes
- Neuroimaging studies
- Consider biomarker testing if results would change management 2