reported better longitudinal sensitivity for MoCA than MMSE.

Greater sensitivity to detect mild levels of cognitive impairment has been reported for the MoCA in MCI and AD dementia, stroke and transient ischemic attack patients and Parkinson’s disease. Though it offers many of the same advantages of the MMSE, the MoCA was developed as a more challenging test that includes executive function, higher-level language, and complex visuospatial processing to enable detection of mild impairment with less ceiling effect. As research increasingly focuses on milder stages of AD, options other than the MMSE are needed for clinicians for earlier diagnosis and management. Its poor sensitivity for distinguishing mild cognitive impairment (MCI) is well-described and can be attributed to a lack of complexity as well as the absence of executive function items. One problem with the MMSE is its ceiling effect or limited dynamic performance range for normal individuals, which increases the likelihood that persons in predementia stages score within the normal range (24 and above). The MMSE is also commonly used as a proxy for staging of Alzheimer’s disease (AD). Though there are a number of possible tests, they recommend the Mini-Mental State Examination (MMSE), the most widely used cognitive screening test used by physicians for general cognitive evaluation, and also the newer Montreal Cognitive Assessment (MoCA). Galvin and Sadowski recently wrote clinical recommendations for primary care physician evaluation of older patients for cognitive impairment, emphasizing the need to look for early warning signs where formal cognitive testing can aid detection. Office-based, multi-domain cognitive tests are commonly administered in clinical situations to evaluate patients with cognitive impairment.

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