The current study was conducted at the University of Missouri – Saint Louis. Results from the total MoCA score analysis were compared to longitudinal performance on a more comprehensive screening measure, the RBANS, to compare changes across time between the two tests. We hypothesized that MoCA scores would significantly increase from the first testing session to the second, with minimal change thereafter. Total MoCA scores were analyzed to reveal differences in performance over time. In the present study we examined changes in performance on the MoCA over a four-year period in healthy older adults. These results are vital to support the utility of the MoCA as an accurate measure of cognitive change and decline in longitudinal research or clinical settings. However, this study did not include further repeated administrations. One recent study that examined change on several neuropsychological tests, including the MoCA, over one 12-month interval identified no change in scores in either Huntington’s disease patients or healthy controls ( Toh et al., 2014).

Although two relatively recent studies have concluded that the use of alternate forms of the MoCA over short intervals of time (60 minutes to one month) may eliminate possible practice effects ( Costa et al., 2012 Chertkow, Nasreddine, Johns, Phillips, & McHenry, 2011), little research has examined longer test-retest intervals and practice effects on the original MoCA. However, few studies have explicitly examined the utility of this measure longitudinally. In the past few years the MoCA has emerged as a preferred screening measure of cognitive status in clinical and research settings. Despite being developed as a more sensitive alternative to the MMSE, it is unclear whether the MoCA is similarly prone to these practice effects. Collectively, these studies indicate that repeated exposure to brief screening measures can result in reduced sensitivity to detect cognitive changes, particularly from the first to second test exposure. Similar practice effects have been observed in two subtests of a more comprehensive screening measure, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS Randolph, 1998) over a test-retest interval of two weeks ( Dong, Thompson, Tan, Lim, Pang & Chen, 2013) although the change in total RBANS score was not significant. These practice effects tend to occur between the first and second testing sessions and are likely due to the small number of items on a screening measure ( Falleti, Maruff, Collie, & Darby, 2006). Previous studies have concluded that screening instruments, such as the MMSE, are also highly prone to practice effects in healthy older adults and in those diagnosed with dementia at short retest intervals of ten minutes to 1.5 weeks ( Galasko, Abramson, Corey-Bloom, & Thal, 1993 Jacqmin-Gadda, Fabrigoule, Commenges, & Dartigues, 1997) and longer retest intervals of three months ( Helkala et al., 2002). Studies have demonstrated the sensitivity of the MoCA to detect cognitive impairment in Parkinson’s disease ( Hoops et al., 2009), cardiovascular disease and stroke ( McLennan, Mathias, Brennan, & Stewart, 2011 Pendlebury, Cuthbertson, Welch, Mehta, & Rothwell, 2010), REM sleep behavior disorder ( Gagnon, Postuma, Joncas, Desjardins, & Latreille, 2010), and brain metastases ( Olson, Chhanabhai, & McKenzie, 2008).Ī recent meta-analysis of practice effects on a range of cognitive tests concluded that practice effects are apparent, particularly in the domains of visual memory, attention, working memory, executive functioning and processing speed, and that greater practice effects are observed for shorter test-retest intervals and tests without alternate forms ( Calamia, Markon & Tranel, 2012). The MoCA has additional utility as a measure of cognitive decline in populations independent of Alzheimer’s disease. As a result, the MoCA has been increasingly utilized as an effective screening measure for detecting MCI in both clinical and research settings. Since the publication of the original validation study, other studies have cross-validated the MoCA as a brief measure with substantial sensitivity to MCI and mild Alzheimer’s disease ( Freitas, Simões, Alves, & Santana, 2013 Luis, Keegan, & Mullan, 2009). Developed in 2005, the MoCA was introduced as a more sensitive alternative to the Mini-Mental State Exam (MMSE Folstein, Folstein, & McHugh, 1975) in detecting the presence of mild cognitive impairment (MCI) and mild Alzheimer’s disease (90% and 100% sensitivity, respectively Nasreddine et al., 2005).

The Montreal Cognitive Assessment (MoCA) is a brief screening measure to determine cognitive status ( Nasreddine et al., 2005).

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