Rather, higher MMSE scores correspond to lower MoCA-30 scores, likely because some of MoCA-30 subtests are more challenging. Equating MMSE to MoCA-30 in the younger-old shows that, although these two tests have identical score range (0–30), they do not have one-to-one correspondence. To facilitate continuity of cognitive tracking in individuals tested with MMSE, MoCA-30, and MoCA-Blind/ Telephone MoCA at different times and to provide comparability of data among multiple studies and trials, the ability to equate scores of these three tests is necessary. The MoCA-30 is more sensitive to mild forms of cognitive impairment, has a higher diagnostic accuracy than the MMSE, and is available at no cost. Recently, many clinical and research settings have switched to using the MoCA-30/ MoCA-Blind/ Telephone MoCA from the Mini-Mental State Exam (MMSE), another common screening measure. However, no norms for MoCA-30 subtests and domains or MoCA-Blind/ Telephone MoCA total score have been published for the oldest-old. To address the need for telephone cognitive screening, Telephone MoCA, identical to MoCA-Blind with slightly modified testing procedures to accommodate telephone testing, was developed and normative cut-points published for younger-old. The second challenge in testing the oldest-old is that prevalent frailty and other comorbidities prevent many of them from travelling to testing sites, which makes telephone screening a method of choice. Henceforth, the sum of in-person MoCA-30 subtests included in MoCA-Blind, that has maximum possible score of 22, is called MoCA-22. MoCA-Blind normative cut-points, to distinguish cognitively normal from cognitively impaired younger-old, were published for the sum of in-person MoCA-30 subtests included in MoCA-Blind. Additionally, MoCA-Blind, that includes MoCA-30 subtests that do not require visual input and has a maximum possible score of 22, was developed to enable in-person cognitive screening of individuals with visual impairment. In that vein, subtest and domain norms in younger-old (older adults younger than 90 years) have been published for one of the most frequently used screening measures, the in-person Montreal Cognitive Assessment that has a maximum possible score of 30 (MoCA-30). In such situations, subtest and domain norms allow for evaluation of completed subtests. First, sensory and cognitive impairments make many of the oldest-old unable to complete all subtests of in-person screening measures, which makes calculation of the total score and its comparison to normative values impossible.

However, cognitive testing of this age group is challenging. Cognitive screening of the oldest-old (age 90 +) has become increasingly important, because this age group has the highest risk of dementia and its projected growth in the coming decades is rapid.

Moca scoring and interpretation