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How about a MOCA alternative?

We’ve got a cognitive-communication screener you might want to add to your toolbox—plus a way to convert between MMSE and MOCA scores.

June 4, 2022

If you’re in the cognitive screening business, you’ve heard of the MOCA. And if you’ve heard of the MOCA, you know it used to be free to administer, but now requires a $125.00 certification fee. This has caused quite a bit of confusion for SLPs, as it seems our training should exempt us from this requirement (which was put in place to ensure quality administration). 


Some SLPs still use the MOCA without certification while others work in facilities that require them to become certified, sometimes even having to pay out of pocket. Whatever your interpretation of the guidelines or the policies where you work, it’s always nice to have another option, especially one that’s supported by evidence. 


Iosa and colleagues found that the Oxford Cognitive Screen (OCS) is a clinically valuable tool for determining cognitive-communication needs in people post-stroke. It’s similar to other cog-comm screeners you may give, but allows you to show areas of impairment and of strength in this caregiver-friendly figure. The OCS is more sensitive than the MOCA, more aphasia-friendly, and is available in many languages.


You can access scoring instructions and administration training videos (including one on remote administration) here for free. You can download a sample version of the test book and patient pack here, but you need to request a license for an unmarked version. These licenses are free if you are using the OCS for publicly funded research or clinical work and if you request the UK English version. 


But we know that some settings or physicians just prefer specific cog-screeners. If you find yourself in that situation, check out this open access solution from Roheger and colleagues. Table 2 converts MMSE scores to MOCA scores for people with dementia—including separate categories of people with Alzheimer’s dementia, vascular dementia, Parkinson’s dementia/Lewy body dementia (a smaller sample), and dementia and stroke. Table 3 does the same thing in reverse, converting MOCA scores to MMSE scores. 

Amanda Filbey, MA, CCC-SLP

Say you’ve got a referring provider who is most familiar with the MOCA, but you’ve already administered the MMSE. Using these conversions can prevent you from having to put your patient with dementia through another screener by allowing you to discuss what the patient’s score is likely to have been on the MOCA. 


No shade to you, MOCA. We still love you, but there are some new resources in town!  


Editor's Note: The original text of this review said that the OCS was simply free. It is, in fact, free for all publicly funded clinical use, but only when you request the UK English version. Translated versions (including US English) incur a cost when you request a license.


Iosa, M., Demeyere, N., Abruzzese, L., Zoccolotti, P., & Mancuso, M. (2022). Principal component analysis of Oxford Cognitive Screen in patients with stroke. Frontiers in Neurology. [open access]


Roheger, M., Xu, H., Hoang, M. T., Eriksdotter, M., & Garcia-Ptacek, S. (2022). Conversion between the Mini-Mental State Examination and the Montreal Cognitive Assessment for patients with different forms of dementia. Journal of the American Medical Directors Association. [open access] 

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