1 Principles of rapid screening of higher cognitive functions
Folstein's Mini-Mental State Examination (MMSE) and Nasreddine's Montreal Cognitive Assessment (MoCA) are the two cognitive screening tests most widely used in medical consultations. Administered in 10 to 15 minutes, they produce a numerical score out of 30, quickly providing objective evidence of whether memory or attention complaints correspond to normal ageing or an underlying neurological condition.
2 Domains assessed and how the tests complement each other
The MMSE explores orientation in time and space, learning and recalling three words, mental arithmetic, language through naming, repetition and comprehension of complex instructions, and constructional praxis through copying two intersecting pentagons. The MoCA is more sensitive in screening for mild cognitive impairment (MCI), incorporating more detailed executive tasks: clock drawing, conceptual switching, mental flexibility and abstraction.
3 Clinical indications and longitudinal follow-up
These scales are indicated for unusual forgetfulness, loss of orientation in familiar places, or sudden difficulty managing finances or driving. Repeated every six or twelve months, they assess the rate of progression of a neurodegenerative disease such as Alzheimer's and help judge the response to stabilising treatments.
4 The place of this approach within care
This approach serves as an initial warning within care: an atypical MoCA or MMSE score is not a definitive diagnosis, but warrants brain imaging with MRI and an in-depth neuropsychological assessment to identify the precise cause of the difficulty.
5 Screening limitations and the role of medical imaging
A reduced MMSE or MoCA score must always be interpreted in light of the person's cultural background and first language. The physician systematically orders laboratory tests and imaging, including MRI, to rule out treatable causes such as deficiencies or subdural haematoma before reaching a conclusion.