Montreal Cognitive Assessment vs. MMSE: Facility Guide

The Centers for Disease Control and Prevention (CDC) states that around 5.8 million people in the U.S. have Alzheimer’s disease or dementia. By 2060, that number of individuals is expected to rise to 14 million. Performing a quick and accurate diagnosis is essential to keeping these vulnerable patients safe. Unfortunately, it can be challenging for healthcare providers to know which cognitive exam to use when diagnosing a patient’s disease.

When deciding whether to use the Montreal Cognitive Assessment vs. MMSE test, there are multiple factors that should be considered to ensure patients receive the best possible treatment. In this article, we’ll review key similarities and differences between each test to help healthcare facility leaders discern when and why they should use one examination over the other.

Why Are Cognitive Examinations Important?

Dementia and other memory loss diseases are diagnosed by tests called cognitive examinations. These exams are short, quick assessments used to identify neurological deficits like memory loss, abnormal reflexes, and altered thought processing. While these exams don’t differentiate symptoms of one neurological disease from another, they help providers recognize the need for additional diagnostic testing.

Without an accurate and timely diagnosis, individuals with cognitive deficits are especially vulnerable to illness and injury. Completing the appropriate cognitive exam can help patients gain access to necessary treatments and services, including:

• Medications that control symptoms or slow the progression of disease.
• Clinical trials.
• Physical therapy and rehabilitation support.
• Financial support.
• Legal protection from discrimination.

The Mini Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are two of the main diagnostic tests used to identify cognitive decline. When presented with a patient’s symptoms, healthcare providers may find it difficult to know whether to utilize the Montreal Cognitive Assessment vs. MMSE. Understanding the key similarities and differences between the two exams will help you get an accurate and timely diagnosis.

The Mini Mental Status Examination (MMSE)

The MMSE, developed in 1975, was created to assess for cognitive disease in patients with new onset neurological symptoms. The MMSE is the most frequently used cognitive test and is therefore considered the “gold standard” when conducting an initial assessment. The test takes 7-8 minutes to complete and examines:

• Visuospatial awareness: (When presented with an image) “Please copy this design.”
• Orientation: “What year is it?”
• Language abilities: “Spell the word ‘world.’ Now, spell it backwards please.”
• Word recall: (When shown a picture of a wristwatch) “What is this called?”
• Attention: “I am going to name three objects. When I am finished, I want you to repeat them. Remember what they are because I am going to ask you to name them again in a few minutes. Ball, car, man.”

The exam includes a variety of multi-part questions and scores patients on a 30-point scale. A score of 9 and lower symbolizes severe dementia, where a score of 25 and higher represents normal cognition. A patient who scores between 10 and 24 displays symptoms of mild to moderate cognitive disease.

The Montreal Cognitive Assessment (MoCA)

The Montreal Cognitive Assessment (MoCA), developed in 1996, is very similar to the MMSE. Both MMSE and MoCA scores are calculated using a 30-point scale and both tests screen for similar neurological deficits.

However, the MoCA is a much more detailed, in-depth version of the assessment. While the questions asked are very much like those included in the MMSE, they’re more difficult to answer correctly. The test also takes longer to complete, averaging 10-12 minutes per assessment. Of the two tests, the MoCA is a more refined and thorough exam. It exists in 35 different languages and can be used with patients who have auditory or visual deficits.

Montreal Cognitive Assessment vs. MMSE: Statistical Differences

We’ve reviewed the key factors involved when administering each examination, but which test is more accurate in diagnosing cognitive disease: Montreal Cognitive Assessment vs. MMSE? Each test’s sensitivity and specificity is reviewed below.

MMSE vs. MoCA: Sensitivity

Compared to the MoCA, MMSE tests are less sensitive to subtle deficits from Parkinson’s or other forms of mild dementia. This means that when diagnosing cognitive decline, MoCA does a better job of discerning the patients that have neurological disease. Those with mild impairment are often missed with the shorter and “easier” MMSE.

MMSE vs. MoCA: Specificity

Despite MoCA’s high sensitivity, the MMSE has a higher specificity. This means that the test is able to correctly identify those who don’t have neurological disease. When used correctly, the MMSE produces fewer “false positive” diagnoses than the MoCA.

When to Use MMSE vs. MoCA: Key Takeaways

When deciding whether to use the MoCA vs. MMSE for dementia, MMSE testing should be used for patients with more significant disease progression. Some of the specific abstraction and visuospatial functioning questions asked on the MoCA are too challenging for those with severe cognitive deficits or a low education level to complete, making the results unreliable.

However, if a patient presents with minor symptoms and questionable functional change, the MoCA should be used to discern mild dementia from signs of the normal aging process. This can prevent patients from slipping through the cracks and missing early treatment windows that could stop the progression of disease.

Stay Up-To-Date on the Most Recent Clinical Advancements

Now that you understand the differences between the Montreal Cognitive Assessment vs. MMSE, you can more accurately and efficiently diagnose neurological disease. If you’re looking for additional resources to improve care quality at your facility, don’t miss out. Our free IntelyCare newsletter shares best practices and care strategies that can help your team perform at its best.