MMSE Score Range and MoCA Scores: What Your Parent's Result Means

Both the MoCA and the MMSE are scored out of 30, and a higher score is better. On the MoCA, 26 or more is in the normal range, 18 to 25 suggests mild impairment, 10 to 17 moderate and 0 to 9 severe, according to the test's developer. On the MMSE, a score of about 23 to 26 or lower is the usual point where doctors look further. Neither test diagnoses dementia on its own.

Families usually find this page the evening after an appointment. The doctor said a number, maybe "22 out of 30," and the visit ended before you could ask what it meant.

Here's the plain version, and what we'd ask the doctor next time.

What do MoCA scores mean?

The MoCA (Montreal Cognitive Assessment) is a 10-minute screening test of memory, attention, language and other thinking skills. Its developer, MoCA Cognition, publishes these ranges for the full test:

Two details trip families up:

• The education point. If your parent had 12 years of schooling or fewer, counted from after kindergarten, one point is added to the total (up to the maximum of 30). A raw 25 can become a 26.
• Mild impairment is not the same as dementia. MoCA Cognition reports an average score of 22 (range 19 to 25) for mild cognitive impairment and 16 (range 11 to 21) for mild Alzheimer's disease. The ranges overlap, which is exactly why the score is a starting point, not an answer.

What is the MMSE score range?

The MMSE (Mini-Mental State Examination) is older, takes about 7 to 10 minutes, and is also scored out of 30. In the Alzheimer Society of Canada's table of screening tools, the MMSE cut-off is 23 to 26 out of 30, depending on the study, and the MoCA cut-off is 25 out of 30.

In practice: a score at or below the cut-off means the doctor should look further. A score above it doesn't rule out a problem, especially in someone highly educated who was very sharp before.

Which is better, the MoCA or the MMSE?

You won't usually get to choose, and it matters less than families think. In primary care, clinicians typically use the MoCA for quick screening and referral decisions. What matters most is that your parent is tested the same way over time, so the doctor can compare like with like.

Can one bad score be wrong?

Yes. A score is a snapshot of one morning, and plenty can drag it down: poor hearing or vision, testing in a second language, a sleepless night, pain, depression, a new medication, or delirium from an infection.

The Alzheimer Society of Canada notes that hearing loss can produce an artificially low score if someone doesn't hear the questions properly. So if your dad left his hearing aids at home, say so.

What matters more than any single number is the trend over time and how your parent is managing day to day: bills, medications, cooking, driving, getting around. Doctors weigh both.

Should you do a MoCA test at home?

We'd skip it. The MoCA's developer says only a health professional should interpret it, and a home score without the official instructions and scoring rules is easy to get wrong in both directions.

If you're worried enough to search for a test, you're worried enough to book an appointment. Write down what you've noticed, with dates, and take it to the family doctor. Our guide to memory clinics in Ontario walks through the referral.

What should you ask the doctor about the score?

1. "What was the score, which test was it, and was the education point added?"
2. "Which parts were hardest for Mom: memory, attention, drawing, language?"
3. "Could anything have lowered the score today, like hearing, medications or an infection?"
4. "Is this enough to refer to a memory clinic, or should we retest, and when?"
5. "What should we watch for at home before the next visit?"

If the answers point toward dementia, our guide to the stages of dementia explains what each stage usually looks like, and the Alzheimer Society's First Link program (Ontario: 416-967-5900) can support you both from the start.