MoCA and RUDAS Flashcards
MoCA
What type of cognitive impairment does MoCA test for?
MoCA = Montreal Cognitive Assessment
Mild cognitive impairment assessed
Which domains are assessed in MoCA?
- attention and concentration
- executive functions
- memory
- language
- visuoconstructional skills
- conceptual thinking
- calculations and orientation
What is the MoCA out of and what is normal?
Out of 30
26 or above is normal
How long does the MoCA take?
10mins
Can the patient use any aids for the calculation task?
No, not even their fingers. This must be done mentally
How is education level accounted for in the test?
If pt has 12 or less years of education after nursery then a point is added to his/her total
How are visuoconstructural skills measured in the MoCA?
Cube drawing - must be 3D, all lines drawn, no lines added, parallel lines (only 1 point given if all done)
Clock drawing of 11:10 - contour drawn and connected (1pt), all numbers/roman numerals inside or outside (1pt), hands joined and giving correct hour (1pt).
How are each of these done in the MoCA?
- Naming test
- Memory test
- Attention test
Naming test - camel, lion, rhino (1pt each)
Memory - “This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn’t matter in what order you say them”. They say the words and you read them again but no points given in these 2 trials. They need to be remembered until end of test Q10 of delayed recall with 1pt per word.
Attention - (1) repeating 5 numbers in the order given (1 number per second) then 3 numbers read at 1 number per 3 seconds which must be repeated backwards. 1pt per sequence. (2) Then: “I am going to read a sequence of letters. Every time I say the letter A, tap your hand once. If I say a different letter, do not tap your hand”. 1pt for 0-1 error. (3) Then subtracting 7 from 100 until told to stop (correct subtractions 1pt each of 4).
How are these domains tested in the MoCA?
- Sentence repetition
- Verbal fluency
- Abstraction
Sentence repetition - : “I only know that John is the one to help today.” then “The cat always hid under the couch when dogs were in the room.” 1pt each only if exactly repeated.
Verbal fluency - “Now, tell me as many words as you can think of that begin with the letter F. [time for 60 sec]. Stop.”. The words can’t be the same with a different suffix. Must generate more than 11 words in 60 seconds for 1pt.
Abstraction - “Tell me how an orange and a banana are alike”. If the subject answers in a concrete manner, then say only one additional time: “Tell me another way in which those items are alike”. If the subject does not give the appropriate response (fruit), say, “Yes, and they are also both fruit.” Do not give any additional instructions or clarification. Then “Now, tell me how a train and a bicycle are alike”. Following the response, administer the second trial, saying: “Now tell me how a ruler and a watch are alike”. Do not give any additional instructions or prompts. 1pt for last 2 pairs. Ruler-watch = measuring instruments, used to measure. The following responses are not acceptable: Train-bicycle = they have wheels; Ruler-watch = they have numbers
How is orientation tested in the MoCA?
“Tell me the date today”
If the subject does not give a complete answer, then prompt: “Tell me the [year, month, exact date, and day of the week].” Then say: “Now, tell me the name of this place, and which city it is in.” Scoring: Give one point for each item correctly answered. The subject must tell the exact date and the exact place (name of hospital, clinic, office). No points even if 1 day error for day and date.
MoCA scoring breakdown:
- Visuospatial and executive functioning: 5 points
- Animal naming: 3 points
- Attention: 6 points
- Language: 3 points
- Abstraction: 2 points
- Delayed recall (short-term memory): 5 points
- Orientation: 6 points
- Education level: 1 point is added to the test-taker’s score if they have 12 years or less of formal education
Which important part of the MoCA is not present in MMSE and is therefore important for dementia?
Testing executive function - deterioration of this may predict dementia in those with mild cognitive impairment
Can detect Alzheimer’s up to 2 years before the MMSE
When is the MMSE better than MoCA?
In severe cognitive impairment
MoCA has 90% sensitivity for mild cognitive impairment compared to 18% for the MMSE
MoCA can uncover cognitive impairment associated with which disorders?
- Alzheimer’s
- Parkinson’s
- Huntington’s
- Lewy body
- VCI/stroke
- Fronto-temporal dementia
- Brain metastases or tumours
- ALS/ MS
- Head trauma
- Depression
- Schizophrenia
- Heart failure
- Sleep behaviour disorder
- Substance abuse
- HIV
What does RUDAS stand for? What is its aim?
Rowland Universal Dementia Assessment Scale - a multicultural cognitive assessment scale which aims to minimise effects of cultural learning and language diversity on the assessment of baseline cognitive performance.
What is the shopping question on the RUDAS?
I want you to imagine that we are going shopping. Here is a list of grocery items. I would like you to remember the following items which we need to get from the shop. When we get to the shop in about 5 minutes time I will ask you what it is that we have to buy. You must remember the list for me. Tea, Cooking Oil, Eggs, Soap.
Give them at least 3 tries to repeat it fully back to you, maximum 5 times. Build rapport, use your fingers when listing the items.
Then they score 2 points per item. You can prompt them saying the first item after 30 seconds if they haven’t named any.
What is the body orientation task in RUDAS?
- (1) show me your right foot
- (2) show me your left hand
- (3) with your right hand touch your left shoulder
- (4) with your left hand touch your right ear
- (5) which is (point to/indicate) my left knee
- (6) which is (point to/indicate) my right elbow
- (7) with your right hand point to/indicate my left eye
- (8) with your left hand point to/indicate my left foot
Once they answer 5 questions, do not continue.
What is the praxis task in RUDAS?
- I am going to show you an action/exercise with my hands. I want you to watch me and copy what I do. Copy me when I do this .* . . (i.e. demonstrate - put one hand in a fist in the vertical position, and the other hand palm down on the table or your knees and then alternate simultaneously.)
- Now do it with me. I would like you to keep doing this action at this pace until I tell you to stop - approximately 10 seconds or 5 – 6 sequences. Keep going until they learn the task.*
Scored out of 2.
What is the drawing task in RUDAS?
Draw the cube shown.
- Please draw this picture exactly as it looks to you (Show cube on back of page). Score as:
- (1) Has person drawn a picture based on a square?
- (2) Do all internal lines appear in person’s drawing?
- (3) Do all external lines appear in person’s drawing?
1 mark for each.
What is the judgement question in RUDAS?
You are standing on the side of a busy street. There is no pedestrian crossing and no traffic lights. Tell me what you would do to get across to the other side of the street safely. (If person gives incomplete answer use prompt: “Is there anything else you would do?”) Record exactly what patient says and circle all parts of response which were prompted.
Score as:
- Did person indicate that they would look for traffic? (YES = 2; YES PROMPTED = 1; NO = 0)
- Did person make any additional safety proposals? (YES = 2; YES PROMPTED = 1; NO = 0)
If they don’t know then repeat the question only once again. If they are in a wheelchair etc then modify the question to “What would anyone who wanted to cross the road have to do to get across safely?”
What is the language question in RUDAS?
Language generativity - animal naming, as many in 1min as possible,as quickly as possible.
Scored out of 8
What is the total score for RUDAS? What indicates possible cognitive impairment?
Total score out of 30
22 or less means possible cognitive impairment
When is the MOCA not valid in terms of education level?
If the patient has had less than 10 years of post-nursery education.
If 10-11yrs then add 1pt to the total they score.
