how about a moca alternative 3 - 6_27_22, 9.05 PM.m4a

Natalie F. Douglas

PhD, CCC-SLP

General

This review was updated from the original version in June 2023.&nbsp;If you’re in the cognitive screening business, you’ve heard of the <a target="_blank" rel="noopener noreferrer" href="https://www.mocatest.org/">MOCA</a>. And if you’ve heard of the MOCA, you know it used to be free to administer, but now requires a <a target="_blank" rel="noopener noreferrer" href="https://www.mocatest.org/training-certification/">$125.00 certification fee</a>. 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).&nbsp;&nbsp;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.&nbsp;&nbsp;<a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.3389/fneur.2022.779679">Iosa and colleagues</a> found that the <a target="_blank" rel="noopener noreferrer" href="https://www.ocs-test.org/">Oxford Cognitive Screen</a> (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 <a target="_blank" rel="noopener noreferrer" href="https://www.frontiersin.org/files/Articles/779679/fneur-13-779679-HTML-r1/image_m/fneur-13-779679-g004.jpg">this caregiver-friendly figure</a>. The OCS is <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1007/s00415-015-7964-4">more sensitive than the MOCA, more aphasia-friendly</a>, and is available in <a target="_blank" rel="noopener noreferrer" href="https://www.ocs-test.org/ocs-background/translations/">many languages</a>.&nbsp;Have you ever had a desperate family member ask, “How will my dad do long-term? Do you think he’ll be able to go back home? How much support will he need?” While we can’t answer those questions with full confidence, <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1016/j.cortex.2023.04.015">Bisogno et al.</a> found that the OCS had some major predictive power post-acute stroke. OCS scores 1 week after stroke predicted memory, mood, emotions, language ability, social participation, and even physical mobility and ADL participation 6 and 12 months later. The worse the OCS score, the worse the long-term functional outcomes, something tangible to potentially inform those hard conversations.&nbsp;You can access scoring instructions and administration <a target="_blank" rel="noopener noreferrer" href="https://informme.org.au/modules/cognition-and-cognitive-screening">training videos</a> (including one on remote administration) <a target="_blank" rel="noopener noreferrer" href="https://innovation.ox.ac.uk/outcome-measures/the-oxford-cognitive-screen-ocs/">here</a> for free. You can download a sample version of the test book and patient pack <a target="_blank" rel="noopener noreferrer" href="https://drive.google.com/drive/folders/19ys7A5suviX4lO_DX_g11LIa2thVNzpI?usp=sharing">here</a>, but you need to <a target="_blank" rel="noopener noreferrer" href="https://process.innovation.ox.ac.uk/clinical/p/ocs/questionnaire/1">request a license</a> 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.&nbsp;&nbsp;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 <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1016/j.jamda.2022.03.018">Roheger and colleagues</a>. <a target="_blank" rel="noopener noreferrer" href="https://www.sciencedirect.com/science/article/pii/S1525861022002882#tbl2">Table 2</a> 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. <a target="_blank" rel="noopener noreferrer" href="https://www.sciencedirect.com/science/article/pii/S1525861022002882#tbl3">Table 3</a> does the same thing in reverse, converting MOCA scores to MMSE scores.&nbsp;<figure class="image"><img src="https://tislp-bucket-assets.s3.amazonaws.com/review_image_6d2af7ff_75e1_47bd_b87d_f5505c8bfa50_614fc96a4f.png" alt="Cognitive-communication screeners, The Informed SLP"><figcaption>Amanda Filbey, MA, CCC-SLP</figcaption></figure>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.&nbsp;&nbsp;No shade to you, MOCA. We still love you, but there are some new resources in town!&nbsp;&nbsp;&nbsp;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.&nbsp;<a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/review/dementia-start-here">This review is part of our “Start Here” content guide for Dementia.</a>

OCS_Sample.pdf

Cognitive-Communication

The Oxford Cognitive Screen provides a visual snapshot of screener results to highlight strengths and weaknesses quickly.

Acute Care

Assessment

Executive Functions/Memory

Standardized Tests

Screening/Prevention

Skilled Nursing Facility

Open-Access Materials

Free to Share

Clinical Resources

Adults (Annual-ARC-Honeycomb)

Birth through Adults (Annual-ARC-003)

Preschool through Adults (Annual, without CE hours)

STUDENT GROUP: University of Oklahoma Health Sciences Center

STUDENT GROUP: Worcester State University

STUDENT GROUP: Western Washington University

Preschool through Adults (without CE hours)

GROUP: DIGNA

Birth through Adults w/ Courses (Annual-ARC-001)

Birth through Adults (without CE hours)

GROUP: Berns Therapy Solutions

GROUP: Fletcher Miller School ( n=5; Full Access)

STUDENT GROUP: Gallaudet University

GIFT TO: Full Access

Adults (Annual, without CE hours)

Adults (without CE hours)

Survey Guest Pass

STUDENT GROUP: Florida State University

Adults (Annual-ARC-001)

STUDENT GROUP: St. Ambrose University

STUDENT GROUP: Old Dominion University

Infants and Adults (without CE hours)

Infants and Adults (Annual, without CE hours)

GROUP: Full Access

STUDENT GROUP: California State University, Sacramento

STUDENT GROUP: Northeastern State University

Members via TISLP Staff

Preschool through Adults (Annual)

Friends of TISLP

GROUP: University of South Carolina (n= 9; Full Access)

TISLP Staff

GIFT TO: Full Access (without CE)

STUDENT GROUP: St. John's University

One Month Free

Birth through Adults (Annual, without CE hours)

GROUP: Harford Academy SLPs (n=1; Birth through Adults)

GROUP: San Diego USD  (n=173; Full Access)

Infants and Adults

Infants and Adults (Annual)

GROUP: West Fargo Public Schools (n=37; Birth through Adults)

Author Access (CE)

Cartoonist Plan

Adults

GIFT TO: Adults

Preschool through Adults

Adults (Annual)

Birth through Adults

6 months free

Archived Membership w/ CE 2021

Birth through Adults (Annual) 

GROUP: ECM- Hudson (n=3; Full Access)

STUDENT GROUP: University of Illinois at Urbana-Champaign

STUDENT GROUP: University of Arizona

STUDENT GROUP: Penn State University

Giveaway Membership

Birth through Adults (ARC-001)

STUDENT GROUP: Appalachian State University

GROUP: University of Wisconsin-Madison (n=8; Full Access)

GROUP: Sound Speech & Hearing Clinic (n = 4; Full Access)

Adults (ARC-001)

Adults (ISHA)

GROUP: Big Stone Therapies (n=3; Full Access)

STUDENT GROUP: Marshall University

Gift to the Grad

STUDENT GROUP: Northern Arizona University

Test free trial plan

STUDENT GROUP: Texas Tech University Health Sciences Center

STUDENT GROUP: Supervising Faculty

Staff Gift

STUDENT GROUP: Abilene Christian University

Gift to the Grad 2023

GROUP: Vista Unified School District (n=36; Full Access)

Free April Trial (MNSHA)

STUDENT GROUP: Bloomsburg University

STUDENT GROUP: Brigham Young University

STUDENT GROUP: Bob Jones University

Birth through Adults (ISHA)

Trial Test

Special: SPA 2022 Free Pass

STUDENT GROUP: Maryville University

ImpSci Guest Pass

STUDENT GROUP: San Jose State University

Adults (SLPShareASale)

GROUP: Staunton City Schools (n=5; Full Access)

One Year Free

GROUP: Boys Town National Research Hospital (n=13; Full Access)

GROUP: THKMC SLT (n=10; Full Access)

STUDENT GROUP: University of New Haven

STUDENT GROUP: The University of Toledo

GROUP: Naperville School District 203 Group B (n=3; Adults)

STUDENT GROUP: Harding University

GROUP:  Mudgeeraba Creek State School (n=4; Full Access)

STUDENT GROUP: Calvin University

STUDENT GROUP: Eastern Illinois University

STUDENT GROUP: University of Memphis

GIFT PAYMENT: Full Access

GIFT PAYMENT: Adults

STUDENT GROUP: East Tennessee State University

STUDENT GROUP: University of Puerto Rico

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.

How about a MOCA alternative? 