MoCA Hindi

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The ICMR-NCTB can be used for clinical and research

purposes after receiving adequate training.
Please email the permission letter to icmr.nctb@gmail.com requesting for

permission to use the ICMR-NCTB
ICMR - NCTB TESTS
(LITERATE)
1
TEST OF GLOBAL COGNITIVE FUNCTION -
MONTREAL COGNITIVE ASSESSMENT (MoCA)
© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB)

2
Contents Page
1. Introduction 4
2. Collection of data: Healthy participants & patients 4
2.1 Procedure
3. Psychometric properties of the Montreal Cognitive Assessment
3.1 Performance of healthy participants on the Montreal Cognitive Assessment 6
3.2 Correlations between demographic variables and Montreal Cognitive

6
Assessment Scores
4. Testing procedure, instructions for administering the tests & scoring
Procedure Montreal Cognitive Assessment (MoCA)
4.1 Montreal Cognitive Assessment – Hindi 9
4.1.2 Generating Norms 15
4.2 Montreal Cognitive Assessment – Bengali 17
4.2.2. Generating Norms 23
4.3 Montreal Cognitive Assessment – Telugu 25
4.4 Montreal Cognitive Assessment – Kannada 32
4.5 Montreal Cognitive Assessment – Malayalam 40
4.6 Test score interpretation 48

1.Introduction
The Montreal Cognitive Assessment (MoCA) was created in 1996 by Dr. Ziad Nasreddine. MoCA
was used as a global cognitive screening tool as part of the ICMR-NCTB project to detect cognitive
impairment. It is a rapid screening instrument with a total score of 30-points and the test can be
administered in approximately 10 minutes. The sensitivity, specificity and cut-off scores of MoCA
for identifying dementia and mild cognitive impairment (MCI) will be published soon.
The test and administration instructions are freely accessible for clinicians at
www.mocatest.org. The test is available in 35 languages or dialects. It assesses different cognitive
domains: attention and concentration, executive functions, memory, language, visuoconstructional
skills, conceptual thinking, calculations, and orientation.
2.Collection of data: Healthy participants centre-wise
2.1. Procedure
Participants were recruited from out-patient services of neurology, geriatric, and internal medicine
clinics of participating hospitals, as well as senior citizen associations and other community centres in
the respective cities. The goal was to recruit individuals aged 40 years and above, with varying levels
of education. Participants with normal cognition, MCI, and dementia due to neurodegenerative disease
and stroke, from both clinic and community, were included in the study.
Based on clinical evaluation, the individuals who fulfilled the following inclusionary criteria
were recruited: participants who were ≥40 years and consented to participate; with no evidence of head
injury, infections, and neurological disorders other than stroke and neurodegenerative disease that
could cause cognitive impairment; with no history of major systemic medical or psychiatric conditions
that could interfere with cognition; and with no significant hearing or visual impairment that could
interfere with cognitive testing.
All study participants underwent cognitive assessment using tests that have been standardised
to the local populations, referred to as “Gold standard battery” for which normative data were
available, and have been in use for clinical diagnosis and research. This battery consists of the cognitive
screening test Addenbrooke’s Cognitive Examination-III (ACE-III) and the Clinical Dementia Rating
(CDR), which is administered in all participants. In addition, in participants with no dementia or
questionable dementia (CDR 0 and 1), tests of episodic memory and executive functions: Rey Auditory
© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) 4

Verbal Learning Test (RAVLT) and Color Trails Test (CTT) were performed to identify participants
with MCI. These tests have been validated and are widely used for diagnosis of MCI in India (Alladi
et al., 2011, 2014; Mathuranath et al., 2007; Nandi et al., 2008; Rao et al., 2004). A participant was
considered to be impaired on a test when his or her performance was below cut-off values in the gold
standard battery.
Clinical diagnosis was made by a neurologist experienced in diagnosis of MCI and dementia
following a semi-structured interview, clinical examination, review of performance on gold standard
tests, and other available investigations. Based on a uniform diagnostic process, participants were
grouped as follows:
1. Healthy controls: All participants who have no subjective cognitive complaints and scored normally
on ACE-III, CDR, AVLT, and CTT.
2. MCI: Participants who fulfill modified Petersen’s criteria for MCI (Petersen, 2004).
3. Dementia: DSM-IV criteria for dementia. Subtypes of dementia will be further diagnosed as follows:
• Alzheimer’s disease (AD): (McKhann et al., 2011).
• Vascular dementia (VaD): NINDS-AIREN criteria (Román et al., 1993).
• Frontotemporal dementia (FTD): (Rascovsky et al., 2011).
4. Vascular MCI: Participants with stroke who fulfill VASCOG criteria (Sachdev et al., 2014).
Median Absolute Deviation (MAD) analyses was carried out to identify the outliers which were
subsequently removed. The demographic characteristics of the healthy cohort and the patient cohort
were given in ICMR-NCTB General Manual -English.

3. Psychometric properties of the ICMR-NCTB
Data was tested for normality across all tests and centres. Parametric tests were administered to data
that was normally distributed and non-parametric tests were carried out for data that was not normally
distributed.
3.1. Performance of healthy participants on the ICMR – NCTB
Tables 1show significant differences in performance on MoCA scores across the five centres. These
differences may be due to demographic differences noted above between centres.
3.2. Correlation of test performance with demographic characteristics across all centres
Table 3 shows the correlation between the demographic factors (age & education) and performance on
Montreal Cognitive Assessment (MoCA). Although most correlations showed significant relations
between the demographic variables and test performance, the correlation coefficients were rather
small, most being below 0.3. Hence, the demographic variables of age and education were not used to
develop norms. Centre wise regression analyses were carried out which also did not produce strong
effects of the demographic characteristics.

Table 1: Performance of the healthy participants on tests of global cognitive function across individual centres
Whole group Centres
Hindi Bengali Telugu Kannada Malayalam
Tests Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD p value
MoCA 26.15 3.28 27.75 2.08 22.50 4.61 26.69 2.38 25.15 2.91 27.28 2.07 < 0.001
*p value indicates significance level of differences across centres using the Kruskal-Wallis test or ANOVA where appropriate.
Table 2: Distribution of missing data across all tests and centres
Hindi Bengali Telugu Kannada Malayalam

N N N N N
Tests Valid Missing Valid Missing Valid Missing Valid Missing Valid Missing
MoCA 184 103 130 59 212 141 148 58 189 81
Correlations were run between age, education and MoCA score across centres to investigate associations between test MoCA score and age and education.
Most correlations were weak, correlation coefficients being under 0.3. (Please see Tables 3)
Table 3: Correlation between tests of global cognitive function and age & education across all centres
Tests Whole group Hindi Bengali Telugu Kannada Malayalam

Age Edu Age Edu Age Edu Age Edu Age Edu Age Edu
Global cognitive function
MoCA -.130** 0.444** -.052 .225** -.239** .792** -.217** 0.226** .169* .135 -.076 .358*
7
MONTREAL COGNITIVE ASSESSMENT
(MoCA) - HINDI

4.1. Montreal Cognitive Assessment (MoCA) - Hindi
Administration and Scoring Instructions
1 Alternative trail making
Administration: The examiner instructs the subject:
,d js[kk [khfpa, tks vad ls ‘kq: gksdj v{kj dh vksj tk,xhA ;gka ls ‘kq: dfj, ¼point to 1½
vkSj js[kk [khfpa, 1 ls d , d ls 2 vkSj 2 ls [k…A ;gka ‘ij var djsaA
1− d - 2-[k - 3- x- 4- M - 5- p
Scoring: Allocate one point if the subject successfully draws the following pattern: 1 − d
- 2-[k - 3- x- 4- M - 5- p, without drawing any lines that cross. Any error that is not
immediately self-corrected earns a score of 0.
2- Visuo Constructional Skills: Cube
Administration: The examiner gives the following instructions, pointing to the cube:
Þuhps nh x;h txg esa ,d ,slk fp= cukbZ;sAß

Scoring: One point is allocated for a correctly executed drawing.
• Drawing must be three-dimensional

• All lines are drawn
• No line is added
• Lines are relatively parallel and their length is similar (rectangular prisms are accepted)
A point is not assigned if any of the above-criteria are not met. Orientation and size does
not matter.
3- Visuo Constructional Skills:Clock:
Administration: Indicate the right third of the space and give the following instructions:
**,d xksy] lwbZ;ksa okyh ?kM+h cukb;s ftlesa 11 ctds 10 feuV dk le; gksA**
Scoring: One point is allocated for each of the following three criteria:
• Contour (1 pt.): the clock face must be a circle with only minor distortion acceptable
(e.g., slight imperfection on closing the circle);
• Numbers (1 pt.): all clock numbers must be present with no additional numbers; numbers
must be in the correct order and placed in the approximate quadrants on the clock face;
Roman numerals are acceptable; numbers can be placed outside the circle contour;
• Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand
must be clearly shorter than the minute hand; hands must be centred within the clock face
with their junction close to the clock centre.
A point is not assigned for a given element if any of the above-criteria are not met. Shape
of the clock does not matter, either square, rectangle or circle shape is acceptable.

4-Naming
Administration: Beginning on the left, point to each figure and say:
Þbu tkuojksa ds uke crkbZ;sß

Scoring: One point each is given for the following responses: (1) lion (2)
rhinoceros or rhino (3) camel or dromedary.
5-Memory
Administration: The examiner reads a list of 5 words at a rate of one per second, giving the
following instructions:
”;g ,d cqf) dh tkap gSA eSa ‘kCnksa dh lwph iM+axw h ftlls vkidks vHkh rFkk ckn esa ;kn j[kuk gSA
/;ku ls lqfu;sxk vkSj esjs cksyus ds ckn ftrus Hkh ‘kCn vkidks ;kn jgsa mUgsa nksgjkb;sxk ¼pkgs ftl Hkh
Øe esa gksa½Aß
ftu ‘kCnksa dks O;fDr igys ifj{k.k esa nksgjkus esa lQy jgsa muds lkeus fu’kku yxk;sa ¼½A
Mark a check in the allocated space for each word the subject produces on this first trial. When
the subject indicates that (s)he has finished (has recalled all words), or can recall no more words,
read the list a second time with the following instructions:
**eSa ;s lwph fQj nksgjkmaxh, /;ku ls lqfu;sxk] ;kn jf[k;sxk] vkSj ftrus ‘kCn gks lds] ¼blls ;k igys
okyh lwph ls½s mUgsa crkb;sxkA**
Put a check in the allocated space for each word the subject recalls after the second trial. ¼½A
At the end of the second trial, inform the subject that (s)he will be asked to recall these words
again by saying:
**tkap [kRe gksus ds ckn esas vkils fQj ,d ckj bu ‘kCnksa dks iwNxaw h] ;kn jf[k;sxk **A
Scoring: No points are given for Trials One and Two
6- Attention
Forward Digit Span: Administration: Give the following instruction:
ÞeSa dqN vad cksyaxw h esjs cksyus ds ckn mUgsa mlh izdkj nksgjkbZ;sAß
Read the five number sequence at a rate of one digit per second.
Backward Digit Span: Administration: Give the following instruction:
Þvc esa dqN vkSj vad@cksyxwa h esjs cksyus ds ckn mUgsa vki mYVs Øe esa nksgjkbZ;sA
Read the three number sequence at a rate of one digit per second.
10
Note: Specific examples can be given in the backward digit span, if that helps the instructions
easier to understand.If the tester is simplifying the instructions- saying in terms of money to
make it more easy..He/she has to make note of that.
Scoring: Allocate one point for each sequence correctly repeated, (N.B.: the correct response for
the backwards trial is 2-4-7).
Vigilance: Administration: The examiner reads the list of letters at a rate of one per second, after
giving the following instruction:
ÞeSa ‘kCnksa dh ,d lwph i<+us tk jgh gwaA tc tc esa vk cksyxwa h vki vius gkFk ls rkyh ctk;sa ;fn vksj
dksbZ vad lqukbZ ns rks rkyh uk ctk,aAß
Scoring: Give one point if there is zero to one errors (an error is a tap on a wrong letter or a
failure to tap on letter A).
Serial 7s: Administration: The examiner gives the following instructionn:
Þ100 esa ls 7 ?kVkb;s tc rd eSa :dus dks uk dgwAa ß Give this instruction twice if necessary.
Scoring: This item is scored out of 3 points. Give no (0) points for no correct subtractions, 1
point for one correction subtraction, 2 points for two-to-three correct subtractions, and 3 points if
the participant successfully makes four or five correct subtractions. Count each correct
subtraction of 7 beginning at 100. Each subtraction is evaluated independently; that is, if the
participant responds with an incorrect number but continues to correctly subtract 7 from it, give a
point for each correct subtraction. For example, a participant may respond “92 – 85 – 78 – 71 –
64” where the “92” is incorrect, but all subsequent numbers are subtracted correctly. This is one
error and the item would be given a score of 3.
7- Sentence Repetition
Administration: The examiner gives the following instructions:
ÞeSa vc vkidks ,d okD; i<+as dj lqukÅaxh esjs cksyus ds ckn fcYdqy oSls gh vki bls nksgjkb;sA ¼dqN
nsj Bgfj;s½ß ÞeSa flQZ bruk tkurk gwa fd vkt jke gh esjh enn djus ds fy;s gSAß Following the
response, say] vc eSa ,d nwljk okD; cksyax w h mls Hkh fcYdqy oSls gh nksgjkbZ;sA ¼dqN nsj Bgfj;s½
ÞfcYyh ges’kk dqlhZ ds uhps Nqirh gS tc Hkh dqRrk dejs esa gksrk gSAß
Scoring: Allocate 1 point for each sentence correctly repeated. Repetition must be exact. Be alert
for errors that are omissions (e.g., omitting "only", "always") and substitutions/additions (e.g.,
"John is the one who helped today;" substituting "hides" for "hid", altering plurals, etc.).
8-Verbal Fluency
Administration: The examiner gives the following instruction:
,d v{kj] tks eS vkidks vHkh crkus okyh gw]a ls ‘kq# gksus okys ftrus vf/kd ls vf/kd ‘kCn vki lksp
ldrs gSa eq>s crkb;sA vki fdlh Hkh izdkj ds ‘kCn cuk ldrs gS f’kok; uke] vad] txg ;k ,sls ‘kCn

11
tks ,d tSls ‘kq# gksrs gS ij [kRe vyx vyx rjhds ls gksrs gS] tSls izse izsfedk vkfnA vkidks ,d
feuV ds ckn #dus ds fy, dgk tk,xkA D;k vki rS;kj gS (Pause) vc eq>s Þikß ‘kCn ls ‘kq# gksus okys
ftrus Hkh ‘kCn vki crk ldrs gS crk,aA [time for 60 es c] #d tkb,A
Scoring: Allocate one point if the subject generates 11 words or more in 60 sec. Record the
subject’s response in the bottom or side margins.
9. Abstraction
Administration: The examiner asks the subject to explain what each pair of words has in
common, starting with the example: tSl%s & ,d dsys vkSj larjk esa D;k lekurk gS. If the subject
answers in a concrete manner, then say only one additional time. **D;k vki**dksbZ vkSj lekurk crk
ldrs gSaIf the subject does not give the appropriate response (fruit), say: ** gka vkSj ;s nksuksa Qy Hkh
gSAa Do not give any additional instructions or clarification. After the practice trial, say:
**vc eq>s ,d Vªsu vkSj lkbfdy esa lekurk crk,** Following the response, administer the second
trial, saying:**,d ?kM+h esa vkSj Ldsy esa D;k lekurk gSA Do not give any additional instructions or
prompts.
Scoring: Only the last two item pairs are scored. Give 1 point to each item pair correctly
answered. The following responses are acceptable:
Train-bicycle = means of transportation, means of travelling, you take trips in both; Scale-watch
= measuring instruments, used to measure.
The following responses are not acceptable: Train-bicycle = they have wheels; Scale- watch=
they have numbers
10- Delayed Recall
**eSaus dqN nsj igys vkidks dqN ‘kCn cksys Fks tks eSaus vkidks ;kn djus dks dgk FkkA mu esa ls ftrus
Hkh vkidks ;kn gSa crkb;sA
Make a check mark ( √ ) for each of the words correctly recalled spontaneously without any cues,
in the allocated space.
Scoring: Allocate 1 point for each word recalled freely without any cues.
Optional
Following the delayed free recall trial, prompt the subject with the semantic category cue
provided below for any word not recalled. Make a check mark ( √ ) in the allocated space if the
subject remembered the word with the help of a category or multiple-choice cue. Prompt all non-
recalled words in this manner. If the subject does not recall the word after the category cue, give
him/her a multiple choice trial, using the following example instruction:
tSls% ** vkidks D;k yxrk gSA buesa ls dkSu&dkSu ls ‘kCn Fks okss Þukd vka[k ;k gkFkß

Use the following category and/or multiple-choice cues for each word, when appropriate:
Category cue Multiple choice

EYES: ‘kjhj dk vax ukd] vka[k] gkFk
SAREE: diM+s dk izdkj lkM+h] iSaV] dqrhZ
TEMPLE: bekjr dk izdkj fo|ky;] vLirky] eafnj
ROSE: Qwy dk ,d izdkj xqykc, xsna k] dey
BLUE: ,d jax yky ]uhyk] gjk
Scoring: No points are allocated for words recalled with a cue. A cue is used for
clinical information purposes only and can give the test interpreter additional information
about the type of memory disorder. For memory deficits due to retrieval failures,
performance can be improved with a cue. For memory deficits due to encoding failures,
performance does not improve with a cue.
11. Orientation:
^êq>s vkt dh rkjh[k crk,a^Â If the subject does not give a complete answer, then prompt
accordingly by saying : eq>s
¼lky] ekg] lgh rkjh[k vkSj lIrkg dk fnu½ crk,aA Then say:
^^vc eq>s bl txg dk uke crk,a vkSj ;g fdl 'kgj esa gSaA^^
Scoring: Give one point for each item correctly answered. The subject must tell the exact
date and the exact place (name of hospital, clinic, office). No points are allocated if subject
makes an error of one day for the day and date.
TOTAL SCORE:
Sum all subscores listed on the right-hand side. Add one point for an individual who has 12
years or fewer of formal education, for a possible maximum of 30 points. A final total
score of 26 and above is considered normal.
Duration:
Time to administer the MoCA is approximately 10 minutes.

Name:
MONTREAL COGNITIVE ASSESSMENT (MOCA) Education: Date of Birth:
Ve r s i o n 7 . 1 H i n d i Ve r s i o n Sex: Date:
?ku dh ?kMhh cuk, ¼11 ctd

?kM+ ctds 10 feuV i½
isa½
udy ¼3 points)
M+ d
[k
?k
Contour Numbers Hands
ifj{k.k lQy jgs rc Hkh vka[k lkM+h eafnj xqykc uhyk No

nwljk ifj{k.k djsaA ikap feuV ds ckn nksckjk iwNsaA 1- ifj{k.k points
2- ifj{k.k
vadks dh lwph i<+s [1 digit/sec.] O;fDr dks blh izdkj nksgjkuk gSA
O;fDr dks mYVs Øe esa nksgjkuk gSA
vadks dh lwph dks i<+sA O;fDr ^vk^ vad lqukbZ nsus ij rkyh nsaA No points if > 2 errors
d [k vk o j e vk vk d e u o vk j vk x /k d e vk vk vk d vk u x
100 esa ls 7 ?kVkb;s
4 or 5 correct subtractions: 3pts, 2 or 3 corrects: 2pts, 1 correct: 1pt, 0 correct: 0pt
nkgjk,
nksgjk,a ÞeSea flQ
flQZ bruk tkurk gwga fd vkt jke gh ejh
esjh enn dju
djus dds fy, ggS A
ÞfcYyh ges’kk dqlhZ ds uhps Nqirh gSA tc Hkh dqRrk dejs esa gksrk gSA
,d feuV esa ÞiÞ ls ‘kq# gksus okys ftrus ‘kCn vki crk ldrs gSaA crkb;sA [ ] _____ : (N > 11 words)
dsys&larjs ds chp dh lekurk&Qy [ ] Vªsu&lkbfdy [ ] ?kM+h &Ldsy
‘kCnksa dks nksgjkuk gS vka[k lkM+h eafnj xqykc uhyk Point for
fcuk dksbZ ladsr fn;s UNCUED recall
Category
g y cue only
Multiple choice cue
rkjh[k eghuk lky fnu txg ‘kgj
© Z. Nasreddine MD
Add 1 point if < 12 yr edu
14
4.1.2 Generating norms (Hindi)
No strong effects of age and education on test performance were found. This maybe secondary to
insufficient representation of all age, gender and education levels in the given sample. Further studies
using the MoCA tests may offer more robust norms from larger age, education and gender stratified
samples. Table 4 display the percentile conversion for raw scores of MoCA test.
Table 4: Mean, SD, and percentiles of MoCA in Hindi
MoCA
Mean (SD) 27.75 (2.08)
Percentile
5th 24
10th 25
15th 25
25th 27
50th 28
75th 29

15
(MoCA) - Bengali

4.2. Montreal Montreal
CognitiveCognitive Assessment
Assessment
(MoCA)
(MoCA) - Bengali
Version 7.1 Bengali version
The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild
cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive
functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and
orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 30
points; a score of 26 or above is considered normal.
1. AlternatingTrailMaking:
Administration: The examiner instructs the subject: "঩মযায়ক্রমভ

঳ংখ্যা-঄ক্ষয-঳ংখ্যা-঄ক্ষয ঄নু মায়ী
গ ার চাকতিগুমরামক গ঩তির তিময় রাআন গকমে ঳ংমমা কযমি ঴মফ । এখ্ান গেমক শুরু করুন (‘১’ গিতখ্ময়
ফরু ন) । ‘১’ গেমক ‘ক’, ‘ক’ গেমক ‘২’, ‘২’ গেমক ‘খ্’ এযকভ কময এআ ঄ক্ষযটি (‘ঙ’ গিতখ্ময় ফরু ন) ঄তি
রাআন গকমে ঳ংমমা করুন ।"
Scoring: Allocate one point if the subject successfully draws the following pattern:
১ – ক – ২ – খ্ – ৩ – – ৪ – ঘ – ৫ – ঙ , without drawing any lines that cross. Any error that
is not immediately self-corrected earns a score of 0.
2. Visuoconstructional Skills(Cube):
Administration: The examiner gives the following instructions, pointing to the cube: “এআ ছতফো
গিখ্ু ন এফং মিো ঳ম্ভফ এো ঠিক বামফ অঁকায গচষ্টা করুন, তনমচয জায় াোমি ।‛

A point is not assigned if any of the above-criteria are not met.
3. Visuoconstructional Skills(Clock):
‚একো
ঘতিয ছতফ অঁকুন । িামি ঳ফ নম্বযগুমরা তরখ্মফন অয ঘতিয কাঁোগুমরা এভনবামফ অঁকুন মামি গফাঝা মায়
এ ামযাো গফমজ ি঱ ঴ময়মছ ।‛
• Contour (1 pt.): the clock face must be a circle with only minor distortion acceptable (e.g.,
slight imperfection on closing the circle);
MoCA Version August 18, 1

2010 www.mocatest.or
© Z. Nasreddine MD g 17
must be in the correct order and placed in the approximate quadrants on the clock face; Roman
numerals are acceptable; numbers can be placed outside the circle contour;
• Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand must
be clearly shorter than the minute hand; hands must be centred within the clock face with their
junction close to the clock centre.
A point is not assigned for a given element if any of the above-criteria are not met.
4. Naming:
Administration: Beginning on the left, point to each figure and say:‚এআ জন্তুোয নাভ ফরু ন। ‛
Scoring: One point each is given for the following responses: (1) lion (2) rhinoceros or rhino
(3) camel or dromedary.
5. Memory:
following instructions: “এো একো ভমন যাখ্ায ঩যীক্ষা । অতভ কিগুমরা ঱ি ফরফ । ভন তিময় শুনমফন এফং
ভমন যাখ্ায গচষ্টা কযমফন, কাযণ অ঩নামক ঩ময এআ ঱িগুমরা ঳ফ ফরমি ঴মফ । অ঩তন গম গকানও
ক্রমভ/঄নু মায়ী ঱িগুমরামক ফরমি ঩ামযন ।”. Mark a check in the allocated space for each word the
subject produces on this first trial. When the subject indicates that (s)he has finished (has
recalled all words), or can recall no more words, read the list a second time with the following
instructions: “অতভ অম য ভি একআ ঱িগুমরা অফায ঩তিময় গ঱ানাফ । মিো ভমন যাখ্মি ঩াযমফন অভামক
ফরমফন। গমআ ঱িগুমরা অম ফমরমছন গ঳গুমরামকও ফরমি ঴মফ ।‛ Put a check in the allocated space
for each word the subject recalls after the second trial.
again by saying, “ অতভ গমআ ঱িগুমরা অ঩নামক ফররাভ, অ঩তন ভমন যাখ্ায গচষ্টা কযমফন। অতভ ঩ময
অফায অ঩নামক তজমে঳ কযফ ।‛
Scoring: No points are given for Trials One and Two.
6. Attention:
Forward Digit Span: Administration: Give the following instruction: ‚অতভ অ঩নামক কিগুমরা
নম্বয ফরফ, অভায ফরা গ঱ল ঴ময় গ মর গ঳গুমরামক একআ যকভ বামফ ফরমফন ।‛. Read the five number
sequence at a rate of one digit per second.
Backward Digit Span: Administration: Give the following instruction: ‚এআফায অতভ অ঩নামক
কিগুমরা নম্বয ফরফ, অভায ফরা গ঱ল ঴ময় গ মর গ঳গুমরামক গ঩ছন গেমক ঳াভমন ঄নু মায়ী ঳াতজময়
ফরমফন । ‛ Read the three number sequence at a rate of one digit per second.
Vigilance: Administration: The examiner reads the list of letters at a rate of one per second,
after giving the following instruction: ‚অতভ অ঩নামক কিগুমরা ঄ক্ষয ঩য ঩য ফমর মাফ। মখ্নআ ‘এ’
© Z.©Nasreddine
Indian Council MD
of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) g 18
঄ক্ষয’ো শুনমফন অ঩তন অ঩নায অঙ্গু র তিময় গোকা ভাযমফন । মতি অতভ ঄নয ঄ক্ষয ফতর িা঴মর অ঩তন
গোকা ভাযমফন না ।‛
failure to tap on letter ‘এ’).
‚এআফায ১০০ গেমক ৭

Serial 7s: Administration: The examiner gives the following instruction:
ফাি তিন । গমআ নম্বয’ ো অ঳মফ গ঳ো গেমক অফায ৭ ফাি গিমফন । এযকভ কময ৭ ফাি তিমি তিমি ফমর মান
মিক্ষণ না অতভ োভমি ফরতছ ।‛ Give this instruction twice if necessary.
point for one correction subtraction, 2 points for two-to-three correct subtractions, and 3 points
if the participant successfully makes four or five correct subtractions. Count each correct
participant responds with an incorrect number but continues to correctly subtract 7 from it, give
a point for each correct subtraction. For example, a participant may respond “92 – 85 – 78 – 71 –
64” where the “92” is incorrect, but all subsequent numbers are subtracted correctly. This is one
error and the item would be given a score of 3.
7. Sentence repetition:
Administration: The examiner gives the following instructions:‚অতভ অ঩নামক একো ফাকয ফরফ ।
অভায ফরা গ঱ল ঴ওয়ায ঩য গ঳োমক হুফাহু এতকবামফ ঩ু নযাফৃ তি কযমফন (঳াভানয তফযতিয ঩য) : "আমি শুধু
জামি রাি-ই সেই যার আজকে যাওয়ার মি঱ িা । " Following the response, say: ‚অতভ অ঩নামক
অফায একো ফাকয ফরফ । অভায ফরা গ঱ল ঴ওয়ায ঩য গ঳োমক ঩ু নযাফৃ তি কযমফন (঳াভানয তফযতিয ঩য) :
সেড়া঱ শুধু খাকের ত঱ায় ঱ু মেকয় পকড় কুকুরগুক঱া ঘকর এক঱ ।
Scoring: Allocate 1 point for each sentence correctly repeated. Repetition must be exact. Be
alert for errors that are omissions (e.g., omitting "only", "always") and substitutions/additions
(e.g., "John is the one who helped today;" substituting "hides" for "hid", altering plurals, etc.).
[Note: Original sentences are, "I only know that John is the one to help today" and" The cat
always hid under the couch when dogs were in the room"]
8. Verbal fluency:
‚অতভ অ঩নামক একটি ঄ক্ষয ফরফ।

অতভ চাআ অ঩তন ওআ ঄ক্ষযো তিময় শুরু মি ঱ি ফরমি ঩ামযন ফরু ন । শুধু গ঳আ ঱িগুমরা ফরমফন না গমো
গকান গরামকয ফা জায় ায নাভ, গকামনা নম্বয, ফা শুনমি একআ যকভ ঱ি তিময় শুরু ঴য় তকন্তু গ঱ল ঴য় অরািা
বামফ গমভন কযফ, কযতছ, কযতছরাভ । অতভ এক তভতনে ঩য অ঩নামক োভমি ফরফ। অ঩তন তক ফু ঝমি
গ঩মযমছন? অ঩তন তক তিতয ? [ ] এফায অ঩তন ‘঩’ ঄ক্ষয তিময় শুরু মিগুমরা ঱ি ‘১’ তভতনমেয ভমধয ফরমি
঩ামযন ফমর মান । [time for 60 sec] োভু ন ।‛

© Z. ©Nasreddine
Indian CouncilMD
of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) g 19
9. Abstraction:
Administration: The examiner asks the subject to explain what each pair of words has
in common, starting with the example: অভামক ফরু ন কভরামরফু অয করায ভমধয তক তভর অমছ ? If
the subject answers in a concrete manner, then say only one additional time: ‚অভামক ফরু ন এআ
দুমো ভমধয অয ঄নয তক তভর অমছ ? ‛ If the subject does not give the appropriate response (পর)
say, ‚঴যাঁ, এযা দুমোআ পর ।‛ Do not give any additional instructions or clarification. After the
practice trial, say: ‚গেন অয ঳াআমকর এয ভমধয তক তভর অমছ ?‛ Following the response, administer
the second trial, saying: ‚গের অয ঘতিয এয ভমধয তক তভর অমছ ? ‛
Do not give any additional instructions or prompts.
Scoring: Only the last two item pairs are scored. Give 1 point to each item pair
correctly answered. The following responses are acceptable:
Train-bicycle = means of transportation, means of travelling, you take trips in both;
Ruler-watch = measuring instruments, used to measure.
The following responses are not acceptable: Train-bicycle = they have wheels; Ruler-
watch = they have numbers.
10. Delayed recall :
‚তকছু ক্ষণ অম অতভ কো ঱ি

Administration: The examiner gives the following instruction
অ঩নামক ভমন যাখ্মি ফমরতছরাভ ওআ ঱িগুমরা অ঩তন অভামক অফায ফরু ন ।‛ Make a check mark (√)
for each of the words correctly recalled spontaneously without any cues, in the allocated space.

2010 www.mocatest.or 20
© Z.© Nasreddine
Indian Council ofMD
Medical Research- Neurocognitive Tool Box (ICMR-NCTB) g
Optional:
Following the delayed free recall trial, prompt the subject with the semantic
category cue provided below for any word not recalled. Make a check mark ( √ ) in the
allocated space if the subject remembered the word with the help of a category or
multiple-choice cue. Prompt all non-recalled words in this manner. If the subject does not
recall the word after the category cue, give him/her a multiple choice trial, using the
following example instruction, ‚ গকান ঱িো অতভ অ঩নামক ফমরতছরাভ, নাক, গচাখ্ নাতক
঴াি ? ‛
গচাখ্ঃ category cue: ঱যীমযয ঄ঙ্গ ; multiple choice: নাক , গচাখ্, ঴াি
঱াতিঃ category cue: এক ধযমণয কা঩ি ; multiple choice: ঩যান্ট ,টি঱ােয , ঱াতি
ভতিযঃ category cue: এক ধযমণয বফন; multiple choice: ভতিয, েু র, ঴া঳঩ািার
গ ারা঩ঃ category cue: এক ধযমণয পুর ; multiple choice: গ ারা঩, াঁিা, জফা
রারঃ category cue: এক ধযমণয যঙ; multiple choice: রার, নীর,঳ফু জ
Scoring: No points are allocated for words recalled with a cue. A cue is used for clinical
information purposes only and can give the test interpreter additional information
performance can be improved with a cue. For memory deficits due to encoding
failures, performance does not improve with a cue.
11. Orientation:
Administration: The examiner gives the following instructions:‚অজমক কি িাতযখ্ ?‛ If the

subject does not give a complete answer, then prompt accordingly by saying: ‚অভামক
ফরু ন অজমক কি ঳ার, ভা঳ , িাতযখ্ অয ঳প্তাম঴য গকান তিন । Then Say: ‚ এফায অভামক ফরু ন গম এআ
জায় াোয নাভ তক অয এআ ঱঴যোয নাভ তক ?‛
TOTAL SCORE: Sum all subscores listed on the right-hand side. Add one point
for an individual who has 12 years or fewer of formal education, for a possible maximum
of 30 points.
A final total score of 26 and above is considered normal.

© Z. ©Nasreddine
Indian CouncilMD
of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) 21
g
© Z. Nasreddine MD
22
4.2.2 Generating norms (Bengali)
Table 5: Mean, SD, and percentiles of MoCA in Bengali
MoCA
Mean (SD) 22.50 (4.61)
Percentile
5th 19
10th 20
15th 22
25th 23
50th 24
75th 25

23
(MoCA) - Telugu
24
4.3. Montreal Cognitive Assessment (MoCA) - Telugu
Montreal Cognitive Assessment
(MoCA)
orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 30
points; a score of 26 or above is considered normal.
1. AlternatingTrailMaking:
Administration: The examiner instructs the subject: " ఒక ఒక

క క . క ('1' ). '1' ' క ', ' క '
'2' '2' ' ' ' ' క క (' ' ).."
1 − క - 2- - 3- గ - 4- ఘ - 5- , without drawing any lines that cross. Any error that
is not immediately self-corrected earns a score of 0.
2. VisuoconstructionalSkills(Cube):
Administration: The examiner gives the following instructions, pointing to the cube: “ ఈ
(copy ).”
A point is not assigned if any of the above-criteria are not met.
3. VisuoconstructionalSkills(Clock):
Administration: Indicate the right third of the space and give the following instructions: “ఒక
గ , 11 గ 10
.”.
• Contour (1 pt.): the clock face must be a circle with only minor distortion acceptable (e.g.,
• Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand must
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© Z. Nasreddine MD www.mocatest.org
25
4. Naming:
Administration: Beginning on the left, point to each figure and say: “ఈ

.”.
5. Memory:
following instructions: “ ఒక క .
గ . గ . క గ
. ఏక ”. Mark a check in the allocated space for
each word the subject produces on this first trial. When the subject indicates that (s)he has
finished (has recalled all words), or can recall no more words, read the list a second time
with the following instructions: “ .
క గ ..” Put a
check in the allocated space for each word the subject recalls after the second trial.
again by saying, “ ఆ గ ,గ .”
6. Attention:
Forward Digit Span: Administration: Give the following instruction: “

, క .”. Read the five number
sequence at a rate of one digit per second.
Backward Digit Span: Administration: Give the following instruction: “

, క క కక .” Read
the three number sequence at a rate of one digit per second.
after giving the following instruction: “ క . ' '
, ఒక .
క .”.
failure to tap on letter ' ').
Serial 7s: Administration: The examiner gives the following instruction: “ ,
ఏ ,ఆ ఆ క ఆ
క 7 ..” Give this instruction twice if necessary.
Scoring: This item is scored out of 3 points. Give no (0) points for no correct subtractions,
1 point for one correction subtraction, 2 points for two-to-three correct subtractions, and 3
points if the participant successfully makes four or five correct subtractions. Count each
correct subtraction of 7 beginning at 100. Each subtraction is evaluated independently; that
is, if the participant responds with an incorrect number but continues to correctly subtract 7
from it, give a point for each correct subtraction. For example, a participant may respond
“92 – 85 – 78 – 71 – 64” where the “92” is incorrect, but all subsequent numbers are
subtracted correctly. This is one error and the item would be given a score of 3.
Administration: The examiner gives the following instructions: “ క ఒక క

. ( ): ఈ
.” Following the response, say: “
క క . .( ):
.”
Scoring: Allocate 1 point for each sentence correctly repeated. Repetition must be
exact. Be alert for errors that are omissions (e.g., omitting "only", "always") and
substitutions/additions (e.g., "John is the one who helped today;" substituting "hides" for
"hid", altering plurals, etc.). [Note: Original sentences are, "I only know that John is the one
to help today" and " The cat always hid under the couch when dogs were in the room"]
8. Verbal fluency:
Administration: The examiner gives the following instruction: “ క ఒక

ఆ క గ .
క . క ఒక .
, ' ' .”
9. Abstraction:
Administration: The examiner asks the subject to explain what each pair of words
has in common, starting with the example: “ఒక క ఏ
క క .”. If the subject answers in a concrete manner, then say only one
additional time: “ఈ ఏ / క క .”. If the
subject does not give the appropriate response (క ), say, “ ,
క క .” Do not give any additional instructions or clarification. After the
practice trial, say: “ ఒక ఏ క/
.”. Following the response, administer the second trial, saying: “ ఒక
గ ఏ క క .”
Scoring: Only the last two item pairs are scored. Give 1 point to each item pair
correctly answered. The following responses are acceptable:
The following responses are not acceptable: Train-bicycle = they have wheels;
Ruler-watch = they have numbers.
10. Delayed recall:
Administration: The examiner gives the following instruction: “ క

క , గ . క ఆ గ
.”Make a check mark ( √) for each of the words correctly recalled spontaneously
without any cues, in the allocated space.
Optional:
Following the delayed free recall trial, prompt the subject with the semantic
category cue provided below for any word not recalled. Make a check mark ( √ ) in the
allocated space if the subject remembered the word with the help of a category or
multiple-choice cue. Prompt all non-recalled words in this manner. If the subject does not
recall the word after the category cue, give him/her a multiple choice trial, using the
following example instruction, “ఈ ఏ క .క
క ?”
క :
category cue: ఒకగ . multiple choice: క , క ,
: category cue: / ఒక క . multiple choice: , ,
గ : category cue: ఒక క . multiple choice: గ , ,ఆ
గ : category cue: ఒక క . multiple choice: ,గ ,
: category cue: ఒక గ. multiple choice: , ,
information purposes only and can give the test interpreter additional information
performance can be improved with a cue. For memory deficits due to encoding
failures, performance does not improve with a cue.
11. Orientation:
Administration: The examiner gives the following instructions: “ క ఈ ”.

If the subject does not give a complete answer, then prompt accordingly by saying:
“ ( , , ).” క ఈ ,
ఏ గ .”
TOTAL SCORE: Sum all subscores listed on the right-hand side. Add one point
for an individual who has 12 years or fewer of formal education, for a possible maximum
of 30 points.

© Z. Nasreddine MD
29
4.3.2 Generating norms (Telugu)
Table 6: Mean, SD, and percentiles of MoCA in Telugu

MoCA
Mean (SD) 26.69 (2.38)
Percentile
5th 22
10th 24
th
15 25
25th 25
th
50 27
75th 28
30
(MoCA) - Kannada

Montreal Cognitive
4.4. Montreal CognitiveAssessment
Assessment(MoCA) (MoCA) - Kannada
orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is
30 points; a score of 26 or above is considered normal.
1. AlternatingTrail Making:
Administration: The examiner instructs the subject: " .

, . (1 ).
2 . ( ).
1 - - 2- - 3- - 4- - 5-
, without drawing any lines that cross. Any error that is not immediately self-corrected earns a
score of 0.
2. Visuoconstructional Skills(Cube):
Administration: The examiner gives the following instructions, pointing to the cube: “
."
Drawing must be three-dimensional
All lines are drawn
No line is added
Lines are relatively parallel and their length is similar (rectangular prisms are accepted) A
point is not assigned if any of the above-criteria are not met.
3. Visuoconstructional Skills(Clock):
Administration: Indicate the right third of the space and give the following instructions: “
. ,
."
MoCA VersionAugust 18, 2010

©Z. Nasreddine MD www.mocatest.org
32
Contour (1 pt.): the clock face must be a circle with only minor distortion acceptable (e.g.,
Numbers (1 pt.): all clock numbers must be present with no additional numbers;
numbers
Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand
must
4. Naming:
Administration: Beginning on the left, point to each figure and say: “ ?”.
5. Memory:
following instructions: “ .
. .
.
. ." Mark a check in the allocated
space for each word the subject produces on this first trial. When the subject indicates that
(s)he has finished (has recalled all words), or can recall no more words, read the list a second
time with the following instructions: “ .
, . ."
Put a check in the allocated space for each word the subject recalls after the second trial.
again by saying, “
.”

©Z. Nasreddine
© Indian MD Research- Neurocognitive Tool Box (ICMR-NCTB)
Council of Medical www.mocatest.org 33
6. Attention:
Forward Digit Span: Administration: Give the following instruction: “

. .”.
Backward Digit Span: Administration: Give the following instruction: "

.
. : 1-4-2 2-4-1- ." Read the three
number sequence at a rate of one digit per second.
Scoring: Allocate one point for each sequence correctly repeated, (N.B.: the correct response
for the backwards trial is 2-4-7).
after giving the following instruction: “ . ' '
. ."
failure to tap on letter ' ').
Serial 7s: Administration: The examiner gives the following instruction: “ 7 100
. 7 .
." Give this instruction twice if necessary.
point for one correction subtraction, 2 points for two-to-three correct subtractions, and 3 points
if the participant successfully makes four or five correct subtractions. Count each correct
participant responds with an incorrect number but continues to correctly subtract 7 from it,
give a point for each correct subtraction. For example, a participant may respond “92 – 85 – 78
– 71 – 64” where the “92” is incorrect, but all subsequent numbers are subtracted correctly.
This is one error and the item would be given a score of 3.
Administration: The examiner gives the following instructions: “

. :
." Following the response, say: “
. :
.”

34
Scoring: Allocate 1 point for each sentence correctly repeated. Repetition must be exact. Be
alert for errors that are omissions (e.g., omitting "only", "always") and substitutions/additions
(e.g., "John is the one who helped today;" substituting "hides" for "hid", altering plurals, etc.).
[Note: Original sentences are, "I only know that John is the one to help today" and " The cat
always hid under the couch when dogs were in the room"]
8. Verbal fluency:
Administration: The examiner gives the following instruction: "

. .
. ,
.( : ,
.)
( : , , , ."
9. Abstraction:
Administration: The examiner asks the subject to explain what each pair of words has in
common, starting with the example: “
." If the subject answers in a concrete manner, then say only one additional time: “
?" If the subject does not give the appropriate response ( ),
say, “ , ." Do not give any additional instructions or clarification.
After the practice trial, say: “ ."
Following the response, administer the second trial, saying: “
."
The following responses are not acceptable: Train-bicycle = they have wheels; Ruler-watch =
they have numbers.
10. Delayed recall:
Administration: The examiner gives the following instruction: “

. .
"Make a check mark ( √) for each of the words correctly recalled spontaneously without any
cues, in the allocated space.

Optional:
provided below for any word not recalled. Make a check mark ( √ ) in the allocated space if the
subject remembered the word with the help of a category or multiple-choice cue. Prompt all
non-recalled words in this manner. If the subject does not recall the word after the category
cue, give him/her a multiple choice trial, using the following example instruction, “
: , , ?"
: category cue: multiple choice: , ,

information purposes only and can give the test interpreter additional information about the
type of memory disorder. For memory deficits due to retrieval failures, performance can be
improved with a cue. For memory deficits due to encoding failures, performance does not
improve with a cue.
11. Orientation:
Administration: The examiner gives the following instructions: “ ." If the

subject does not give a complete answer, then prompt accordingly by saying: "
( , , , ) . " Then say "
?"
Scoring: Give one point for each item correctly answered. The subject must tell the exact date
and the exact place (name of hospital, clinic, office). No points are allocated if subject makes
an error of one day for the day and date.
TOTAL SCORE: Sum all subscores listed on the right-hand side. Add one point for an
individual who has 12 years or fewer of formal education, for a possible maximum of 30
points.

©Z. Nasreddine MD www.mocatest.org 36
NAME:
MONTREAL COGNITIVE ASSESSMENT (MOCA) Education: Date of birth:
Sex:
Version 7.1 Kannada Version DATE:
VISUOSPATIAL / EXECUTIVE ( POINTS
) Points )
5
2
1
4
3
[ ] [ ] [ ] [ ] [ ] __/5
Contour Numbers Hands
NAMING
[ ] [ ] [ ] __/3
MEMORY .
. No
1 points
.5 . 2
.
ATTENTION
1
Digit/sec) __/2
. No points if ≥ 2 errors
[ ] , , , , , , , , , , , , , , , , , , , , , ,
__/1
100 7 . [ ] 93 [ ] 86 [ ] 79 [ ] 72 [ ] 65
4 or 5 correct subtractions: 3pts, 2 or 3correct: 2pts, 1 correct: 1 pt, 0 correct: 0 pt __/3
LANGUAGE : [ ]
[ ]
__/2
[ ] _____ (N ≥ 11 words) __/1
ABSTRACTION : - = [ ] -- [ ] - __/2
DELAYED RECALL Points for __/5
[ ] [ ] [ ] [ ] [ ] UNCUED recall
Category Cue
only
Optional
Multiple Choice Cue
ORIENTATION [ ] [ ] [ ] [ ] [ ] __/6
© Z.Nasreddine MD www.mocatest.org Normal ≥ 26 / 30 TOTAL __/30
© Z. Nasreddine MD
Administered by: ___________________________________________________ Add 1 point if ≤ 12 yr edu
37
4.4.2 Generating norms (Kannada)
insufficient representation of all age, gender and education levels in the given sample. Further
studies using the MoCA tests may offer more robust norms from larger age, education and
gender stratified samples. Table 7 display the percentile conversion for raw scores of MoCA test.
Table 7: Mean, SD, and percentiles of MoCA in Kannada
MoCA
Mean (SD) 25.15 (2.91)
Percentile
5th 22
10th 23
15th 24
25th 25
50th 25
75th 27

38
(MoCA) - Malayalam

4.5. Montreal Cognitive Assessment (MoCA)- Malayalam
A D M I N I S T R A T I O N AND S C O R I N G I N S T R U C T I O N S
1 Alternative trail making
Administration: The examiner instructs the subject:
c3%GOOan6co{^>a(im5\<n5 CTDO6UJQQ51CCS5 arilarD «3T3taiaocaia51<sei<es)

0 0 S303 aica aioas^ca.
SOJIOS co)3S63T33cft> (i <39i<a5) ajg6n^d36)06rr51d3£>3<e>). ' i ' cod a51ax>° 'ca>' srfksBkas) coraoitos
0
ailam 0 ca6nileej<fKiJ d®arr5l63T36XD Qicd<a>a5 Qio<9S}3<e>. g) olios <Braaicrcoa51c^l<s£)3ca. 'ai'

cDileejd3S)° nig6n$<es)O6r6\<esi£<0>.
I - <6» - 2 - 6H - 3 - C D - 4 - " e i - 5 - 6 n
Scoring: Allocate one point i f the subject successfully draws the following pattern:
1 - t a J - 2 - 6 u - 3 - c o - 4 - a e j - 5 - 6 i 3 without drawing any lines that cross.

Any error that is not immediately self-corrected earns a score o f 0.
2- Visuo Constructional Skills: Cube
Administration: The examiner gives the following instructions, pointing to the cube:
crooa)s><fiS)06rD3crD oruaeicaraj fD<D.afl(<£Do aicacDitegca..

0
• A l l lines are drawn
A point is not assigned i f any of the above-criteria are not met. Orientation and size does
not matter.
3- Visuo Constructional Skills:Clock:
6icd3 neisl<e>ocdo aicdwf<ss)&cB> , o®gjo carataoasnggo c^sgcojgrf^., croacrDo 11 Q6rol to O1CD1§ j
aioaf ca>06rol<es)3ca>.
• Contour (1 pt.): the clock face must be a circle with only minor distortion acceptable
(e.g., slight imperfection on closing the circle);

• Numbers (1 p t ) : all clock numbers must be present with no additional numbers;
numbers must be in the correct order and placed in the approximate quadrants on the
clock face; Roman numerals are acceptable; numbers can be placed outside the circle
contour;
• Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand
must be clearly shorter than the minute hand; hands must be centred within the clock face
with their junction close to the clock centre.
A point is not assigned for a given element i f any of the above-criteria are not met. Shape
of the clock does not matter, either square, rectangle or circle shape is acceptable.
4- Naming
Administration: Beginning on the left, point to each figure and say:
Scoring: One point each is given for the following responses: (1) lion (2) rhinoceros or
rhino (3) camel or dromedary.
5- Memory
Administration: The examiner reads a list o f 5 words at a rate of one per second, giving
the following instructions:
6DCa>° 63Cd3 6JOC0O2 cJCdlGCfaOCJDOJQQ>06rri! 6KDOCT8 <a>3@0 QJO<6E)3t9>gS63rilaD 6303 dJ§l<a>

QjOQo5]d35)oa3 (gcJOcBânDg. ax>o&,ad caracco 0 (cracsolajg Gc&,o&<a?>£c&><XD£o 5iociacxoS\«si
câ»1a>3cS><x»3o ©aiaroo. 6TCDOO3 aiocDil^jgtejslcDjgcscQioaB (mo^,a6<asf
6ioc5(rmsiic6i<asiocoocii^cro aJoaoQiai) aio<a£>3da>ao cjo<x»6roo. (ca>o©>od Qio<a£>3<ajC/o a©ca>°
(<BDQCaK»lcod oJ06KBOejgo cBigSôlgl).
c3%Gj6X0K» (aaacoK»lcad cJcaleo3oa51ca)ff)oas3crD aij<efa51 aacdlci»oa»] oJociDgcro

63oecdoaio<ss51ao3o csraaâidlaj^gg ODioeicoTCD 6303 <so6Dcn>ls3ca>. ( V )
0
Mark a check in the allocated space for each word the subject produces on this first trial.
When the subject indicates that (s)he has finished (has recalled all words), or can recall no
more words, read the list a second time with the following instructions:
6rcDoa3 <ura<3<3D oJ§]c&.«»6xro 6303 oi§oda>gsl aiocDilaooai GaJOcaârDg.

630cda2)ajlCdld3»3QIOaD3a CCDO®>a3 «JT§)Gj£XDK» (oJOQIC/ajo oJ063T3CCD3a3sDc£IS)S aJCdaOQJCDl
o\o<es)$<&,u5 aflonBgo aJOQCDgoiocDgo (c/9al<e653<s>. aijceraSl cdorreoasxara) (oaacaraSlcad
oacalcQJocnil cjoocoyro 63oecdoaio<ss51cD3o ailcdglaas croiaeicorco S303 carascroogo 0
cscd 6ii 65ayls3cara>3<a,.
Put a check in the allocated space for each word the subject recalls after the second
trial. (V )
41
At the end of the second trial, inform the subject that (s)he will be asked to recall these
words again by saying:
rjo1(3r/3oaxDCLD3<os caraaiaroocoo (saca3c£io6TaK» QjOd3S)3c&>ad ctHensgo ojoctogoioad 6KDOO8
Scoring: No points are given for Trials One and Two
6- Attention
Forward Digit Span: Administration: Give the following instruction:
6K»oo5 ailej croo6Uj<a>a8 ajoa»oa3 SoJOtQ^cnDg. 6KDOCT3 aroo6iJ5te>ad ojo6rara3c3aao2io croo©>od

ov)o6ujca)g3ff)s nj§lca> 6K»OCT3 oJ06iarc» caraeco) (^>aamS\<xs5 c3%<aiakoTa51ee5)6iDo.
Backward Digit Span: Administration: Give the following instruction:
g>(3<ijoao 6ra)oad SOISDO ailei ax>osujc&>ad da>gsl OJOQDJOCTS SaJOcBânDg. 6K»oa3 Gjo6Tarmca51a)3
eadcfiio ca>o©3(/3 arooQijcejggos o_i§lcej6xr» ™g)ca5)c3 (âcaraflcazS <B%aic3carojl<sK)6rDo.
Read the three number sequence at a rate of one digit per second.
Note: Specific examples can be given in the backward digit span, i f that helps the
instructions easier to understand. I f the tester is simplifying the instructions- saying in
terms of money to make it more easy. He/she has to make note of that.
Scoring: Allocate one point for each sequence correctly repeated, (N.B.: the correct
response for the backwards trial is 2-4-7).
after giving the following instruction:
6K»3o8 c3racS>acas3T3§3S3S 6303 nj§l<s> cuoQo5lc85)oa3 <ScJOce>3arD3. 6KDOOO cara cx0crD c3race>aoo
cJoa»3crD 630(Sc9oca)oi6rDCDJ3o a»o©5o5 6>G)<£hG}£h06(x€ (saaaGQcad 6303 ai§o 6)da>o§3<&>.
6K»oa3 cara C3raej06xro QSDgsjaco^lejgo csra<ei2JCdo oJoctDgeaoioad S>CS>O§03CCD!
Scoring: Give one point i f there is zero to one errors (an error is a tap on a wrong letter or
a failure to tap on letter A).
Serial 7s: Administration: The examiner gives the following instruction:
gDScaood 6TO)oa5 ccDO®jegos° ODgolcod oolano n®s>° ^ 3 0 o f 0^600301008 <s%cycraj6>as3crD3.

0
ci®arril§° 6K»oa3 crooêgos aolcdcoKBoaS

0 c3Tâj«3^6>as3cno<£D3ai6xa a»o^>g3©s
g(DKDC9COia)l«j3 00)01030 a®S>3 <B330aJ3S)<e.06rfilcdl<flE)6rDo.
Give this instruction twice i f necessary.
Scoring: This item is scored out o f 3 points. Give no (0) points for no correct
subtractions, 1 point for one correction subtraction, 2 points for two-to-three correct

42
subtractions, and 3 points i f the participant successfully makes four or five correct
subtractions. Count each correct subtraction of 7 beginning at 100. Each subtraction is
evaluated independently; that is, i f the participant responds with an incorrect number but
continues to correctly subtract 7 from it, give a point for each correct subtraction. For
example, a participant may respond "92 - 85 - 78 - 71 - 64" where the "92" is incorrect,
but all subsequent numbers are subtracted correctly. This is one error and the item would
be given a score of 3.
7- Sentence Repetition
6K»ocr3 a»o©)63g 6303 aioaica.o oiocDilaf <Sca>O0cijlc8E)oa3 SaJOca^crog. arooarS

oJoa»3cro(rD3<8oJOS>ej crosxro caracal «j%Qic3caroild3S)3c&.. ârâoôcDilceeigaioaaoaDil
gggctD (s^06rr51ciB0635rDanD ao(a»o ™j)(X)lesx5]a»oc>. Following the response, say
0 o
gDC3c?Joc/3 6KDoar3 (TOoaffli QQisio 6io% oioaj<a>o oiocrola/ <3da>o3ci51cas)oa3 enJOceânog.

6rr»oo5 oJoacDganDccDgcgoJooej CCDSDCTD «3T3ffB° c3Tg)aic3cara51cffi)3<a>. agdlcoilcao oJ§lca>a3
QicrD(Soaos)s>a)ca5 ajg^j <e>§lejlcDsla»lcod aglajg.
Scoring: Allocate 1 point for each sentence correctly repeated. Repetition must be exact.
Be alert for errors that are omissions (e.g., omitting "only", "always") and
substitutions/additions (e.g., "John is the one who helped today;" substituting "hides" for
"hid", altering plurals, etc.).
8- Verbal Fluency
6KDOCf3 CCDO^CSgOs' 6D<gc£10Qd «3T3cei2dCdaoeiQDil6DPJ 6303 (STdcBaaOo oJOQDJgo (oJOXXtDgCO)

(Brateaaoo 6Dca>06n§' crogseangano ojoaoaiail oio<ss)3ce>a3 croogâS nêanoos ojoocoeroo 0
aruaejajnggoseomo (srajggcBaggosecrDo <3aJ03ca>ad, gGOaOoanoo ojdaaDosad, ajloaio,

aoo6iijce>a5, gGOciOosrDo oj«351oo6rgjit oraajcroooDocarcD ci£Ba»oco3o <Bra<ai2icas3r3ad
s)c&)05rr§3ao(OT)o csracdcaiao aijccDjoav)6>c2is3crD ajj)anoocj3 cd<3<roâca6QJcnjDQ3gg QiOd3S)3c&>a3
gGOd006TOo 6306TDo, 6306TDC3tffi)OSl, 6306TOCDia>gf nJJ)CTO\Oi5i(Xi)0 s\S)c&> n®ff»30»Cdo
(
aiOcffi)3tejg3o ojoccooo. 6303dlodl§ <9><s\(xr>z<3cn\ocr& 6K»oa3 crooêgos" aDl«karcx>oa3 ojooojga

0
a»os>ad <x»co)oooc36rDO. aaca) ' a j ' n4)crD csracBaacao £><s>06rf3 ca>3S63i33criD ajcaaoaiail
0
ojo<es)3da>od ajoa»3<e>.(60 6}crod3S)cg$ oroacroo) oacal colakarc»3ca>.

J
Scoring: Allocate one point i f the subject generates 11 words or more in 60 sec. Record
the subject's response in the bottom or side margins.
9. Abstraction
Administration: The examiner asks the subject to explain what each pair o f words has in
common, starting with the example:
gGOouOca6roaocDJl 530O6rgji3o OJOS>C£JS>OJ3O croa2fleJ3gg oooaâoax

I f the subject answers in a concrete manner, then say only one additional time,
go ojccoaileiggg 0 0 0 0 0 3 orooajo oJO(r»3da>.
I f the subject does not give the appropriate response (fruit), say:
goal 0611330 aJ»eai3iJ3aoanr>*
Do not give any additional instructions or clarification. After the practice trial, say:
go oil 6303 £>(SQQ51CO3O 6D63aroca51i3o croaale^gg oooajo oJocmgcSj.
Following the response, administer the second trial, saying
63C93 cro°cS>QQ51ei3o OJ0.3J30 crooale^gg orooajo oJoa»3c&>.
Train-bicycle = means o f transportation, means of travelling, you take trips in both;

Scale-watch = measuring instruments, used to measure.
The following responses are not acceptable: Train-bicycle = they have wheels; Scale-
watch= they have numbers
10- Delayed Recall
6K»ood OTd&ikjocooo 03080/ (TOoeiOg ailai QiOd3£>3da>a5 aioooil^f <gdajo3c£i)<a£>3c&>Qcc>3c>

croo®3(S§os careen 6joc5<m»3c^crx>d3£)3aioo5 c3ra_aio3jS)c£is3cBar)3o 63c2j(roffDlc330io3aiegJo.
0 ) J
caraaiooilcad <mo(&>cs5<es? gDcscHOC/d 630(3a2QDJleJ3§g ojoaoojail aio<s£>3c&>a3 ojoa»3ca>.
Make a check mark ( V ) for each of the words correctly recalled spontaneously without
any cues, in the allocated space.
Optional
provided below for any word not recalled. Make a check mark ( V ) in the allocated space
i f the subject remembered the word with the help of a category or multiple-choice cue.
Prompt all non-recalled words in this manner. I f the subject does not recall the word after
the category cue, give him/her a multiple choice trial, using the following example
instruction:
ag£s> 33611 o s>6>e> iDca5teaj(roocDjTd30io3 <B% orxasf rôooem" ca>oaa>a8<e6>° G C E D O O T ^ O Q C O X

Category cue Multiple choice

EYES: aac^lcdcoToilsjcfd socoo
o
SAREE: QOgffDCdo QICrO(CCDo croocdl, cAoaS] oac3§°
TEMPLE: 6303C05C30 6)c&>§)So n j g g l t ^ g s o , (3%c/a3oJ(co51, oracoieio
ROSE: ooocro, a3gj, coooaca
BLUE: 65C33 COlOo
SCORING: No points are allocated for words recalled with a cue. A cue is used for
clinical information purposes only and can give the test interpreter additional information
Performance can be improved with a cue .For memory deficits due to encoding failures,
performance does not improve with a cue
11 Orientation
g3crD6DcarcD coSlcrncail ojoa»3da>. I f the subject does not give a complete answer, then prompt
accordingly by saying o®<sarDos° gaaosxara) (aic3a2io, aoaroo, <e^ccDjflO(x» cafkrocaS),
(Bi3)S>^|cr»la>ej olaicrocarailsDqd @oj® ) t crCDcrrilai aJoa»3ce>. Then say: oacdl 12 col giro
axaeicoKolsjqd <3oJca° oJocrD3ca>. <a>gsos)aB croneio a£}CCD° gglgjacDlejocsro" o®crD3o aJoci»3<eD.
Scoring : Give one point for each item correctly answered. The subject must tell the exact
date and the exact place (name of hospital, clinic, office) No points are allocated i f
subject makes an error of one day for the day and date.
TOTAL SCORE: Sum all subscores listed on the right hand side. Add one point for an
individual who has 12 years or fewer of formal education, for a possible maximum of 30
points. A final total score of 26 and above is considered as normal.
Duration: Time to administer the MOCA is approximately 10 minutes.

M O N T R E A L C O G N I T I V E ASSESSMENT- M O C A <3ciJo ;
VERSION - 7 M A L A Y A L A M VERSION oilqpspcruo'.
Q j l G o a j o crvD°(3oJaaj(ij3/c^caja^<e!)jg§1ar
<fl3U60jln5 a J l ( « 5 ) o aJd&COCOTTOlda) , n °
d d " 6 ( t r o a c i H o cJccDlooDoanDg
x—\
0 0 ' e tD
0 [ ] t ]
[ ] [ ] [ ]
<m>)<a>yaSl ooosa^<9icii cTOaaJl<e>a3
<3nJO alO<XD%&,
i
tSa6MP° croocal (Bracnieio SOOOVj cdlai
d3»Gld 22 PI
Qio<an3(S>g36)s «j§lcja> aioaoil<ss>3<a>. [ ] [ ] t ] [ ] [ ]
<iical(3a3oa51<SE)a)<iiS3arr) aij<9flj5l ajraai
(B%oj(caoo
orajOidcairolifiraafOo. o ^ a j s x n K D (oaao ccnaarn
oil83aB<a>c9ao(i»oa3o casn§" (craa63ng3o
aDscDKD3iS). (Bra6ra!f alcol§lcD3 ecracjao
630c3a3l<ss>oa3 (c©ata>3(ja>
•••H t3ra<s5)63ng355s a j ^ l a > Qioa»)<sn3(ai oJcal<3cacxold3o«><iis30nD afj<ara>l aetroosaacarafle!*)* c^«a5(aiai1<e6>6tna [ ] 2 1 8 5 4

(63a3oaro<s6X|6Tca3 3 3 3 cara.eoo agyxn crikaasSlcod) <jcalsc/aoa51cSS)6>cHS3crr) QijtQraJl ciilcJcaT<ai(âcina51ctJu cBiajOjnkcncotesierno [ ] 7 4 2
(Bra<aiacaa3t3g3S)s <J§1^> QIO<Q51CSS>3<9J. a o e o o 'cara' a3ra<saaca<iiK»laD3o cJca1ecraoaAss)63e3S3anD Qi5<eraSl 6>6}<a>s><a>oem eaaaackad

£>da>o§6noo. 53arr51(Dd<as)as3i3»cod 6xc»g3d*c/d<an"eajcxnflc$"sg-
<J, 6QI, (313, (S>, 3 , CD, C3I3, 0313, 83, <a>, HI, 6DJ, C3T3, « J , S3T3, <&>, S, g » , C3I3, 8313, S3, 0313, a , 63, e j , 0313, C3T3, 6111 I
coaolcod a J l c m " < ^ » 3 ^ 3 0 ^ " OS<3CIDC>§ C^6IT)3<Q>

0 [ ] 93 [ ] 86 [ ] 79 [ ] 72 [ ] 65
CDoaaio caraaaraao aacakcoow d^MdsraeJco aacro <3ciX>0Q>1cg>" os6n30 aaecroo cracdlsef osn?" SaJOGoflcgJ"; 6333 coolest 6303 ScJomflqjS ; n f f l g p o
0 1
CT3jciicdcoK)51cas)3<s>. S C T D " croôaDteigaracTJociJil gggcro* <3sso6Tola»06i6Tnan' ao(8Bo ag)c6\<es>a\(woo [ ]

a3dl(DilcDd oj§l<s>c/d cacro(sîos)VOS)<BSi <jgaj AgloilcDslaiilcad 63glaJ3. [ ]
S3.s>3<ss)" 63C93 alail§363cei06n5' ' e j ' asjyro (Ba<aa®o oiqf ODgSfflBgarD < j o a o o i c o l ojo<9a3ca>c/3 oJoci»3c&> [ ] aK&texoocnSkisA
croaoa>oj> oj5<9fl»a3<es>3da>. g a o . Qios cns o, 630O6rai" -0611530 c j s e a r a g o e m "

, , 6>(sa»lciu - 6363cro<ss>la3
oroool caracmeio
63ociaite>ajs3«>sroo
t ] [ ] [ ] [ ] [ ]
ailsocoajctJKD.acilocDaaa ciua-aico
aoSskjlo^ Siiioorotivr crag aicn
[ ] aoauo [ ] QK3<i2k) [ ] CSQKTOO [ ] cmaeio [ ] <j§smo/(CDoao
Total : / 30
© Z. Nasreddine MD 46
4.5.2 Generating norms (Malayalam)
Table 8: Mean, SD, and percentiles of MoCA in Malayalam
MoCA
Mean (SD) 27.28 (2.07)
Percentile
5th 24
10th 25
15th 25
25th 26
50th 28
75th 29

4.6. Test Score Interpretation:
Normative data are used to compare characteristics or specific conditions of a group of people or
an individual with a reference population and aid in the detection of deviations (Ware & Keller,
1996). Normative scores assist test takers in interpreting the test results as raw scores are not
meaningful without proper interpretation. Percentile ranks (PR) or percentiles (PC), standardized
scores, and standard scores are all typical ways to describe norms (Gregory, 2007). To derive
norms for tests of the ICMR-Neuro Cognitive Tool Box (ICMR-NCTB), the percentile rank
method is used. Tables 4-8 display the percentile conversion (5th, 10th, 15th, 25th, 50th and 75th)
for raw scores for the MoCA test.
Depending on the clinical applicability, the appropriate norms can be chosen from 5th to 75th
percentile. As per the available literature, scores below 15th percentile can be considered to be
indicative of probable cognitive deficit (Rao et al., 2004). Additionally, the 10th percentile can be
used to identify patients with severe cognitive deficits (Mistridis et al., 2015). Values of 15th and
10th percentiles for the MoCA test of the ICMR-NCTB are provided in this manual to help
the clinician/researcher in interpreting the individual raw scores.
References:
Ware, J. E., Jr., & Keller, S. D. (1996). Interpreting general health measures. In B. Spilker (Ed.), Quality
of life and pharmacoeconomics in clinical trials (2nd ed., pp. 445–460). Philadelphia: Lippincott-Raven
Gregory, R. J. (2007). Psychological testing: History, principles, and applications (5th ed.). Boston:
Pearson Education
Rao, S.L., Subbakrishna, D., & Gopukumar, K. (2004). NIMHANS Neuropsychology Battery-2004,
Manual. Bangalore, India: National Institute of Mental Health and Neurosciences.
Mistridis, P., Egli, S. C., Iverson, G. L., Berres, M., Willmes, K., Welsh-Bohmer, K. A., & Monsch, A. U.
(2015). Considering the base rates of low performance in cognitively healthy older adults improves the
accuracy to identify neurocognitive impairment with the Consortium to Establish a Registry for
Alzheimer's Disease-Neuropsychological Assessment Battery (CERAD-NAB). European archives of
psychiatry and clinical neuroscience, 265(5), 407–417. https://doi.org/10.1007/s00406-014-0571-z

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The ICMR-NCTB can be used for clinical and research

Please email the permission letter to icmr.nctb@gmail.com requesting for

© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB)

2. Collection of data: Healthy participants & patients 4

3. Psychometric properties of the Montreal Cognitive Assessment

3.1 Performance of healthy participants on the Montreal Cognitive Assessment 6

3.2 Correlations between demographic variables and Montreal Cognitive

4. Testing procedure, instructions for administering the tests & scoring

Procedure Montreal Cognitive Assessment (MoCA)

4.1 Montreal Cognitive Assessment – Hindi 9

4.1.2 Generating Norms 15

4.2 Montreal Cognitive Assessment – Bengali 17

4.2.2. Generating Norms 23

4.3 Montreal Cognitive Assessment – Telugu 25

4.3.2 Generating Norms 30

4.4 Montreal Cognitive Assessment – Kannada 32

4.4.2 Generating Norms 38

4.5 Montreal Cognitive Assessment – Malayalam 40

4.5.2 Generating Norms 47

4.6 Test score interpretation 48

2.Collection of data: Healthy participants centre-wise

© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) 4

• Alzheimer’s disease (AD): (McKhann et al., 2011).

• Vascular dementia (VaD): NINDS-AIREN criteria (Román et al., 1993).

• Frontotemporal dementia (FTD): (Rascovsky et al., 2011).

© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) 5

3.1. Performance of healthy participants on the ICMR – NCTB

© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) 6

Table 2: Distribution of missing data across all tests and centres

Hindi Bengali Telugu Kannada Malayalam

Tests Whole group Hindi Bengali Telugu Kannada Malayalam

© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) 8

1 Alternative trail making

Administration: The examiner instructs the subject:

2- Visuo Constructional Skills: Cube

Þuhps nh x;h txg esa ,d ,slk fp= cukbZ;sAß

• Drawing must be three-dimensional

3- Visuo Constructional Skills:Clock:

© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) 9

Þbu tkuojksa ds uke crkbZ;sß

Forward Digit Span: Administration: Give the following instruction:

Backward Digit Span: Administration: Give the following instruction:

Serial 7s: Administration: The examiner gives the following instructionn:

Administration: The examiner gives the following instructions:

Administration: The examiner gives the following instruction:

© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB)

10- Delayed Recall

Administration: The examiner gives the following instruction:

© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) 12

Category cue Multiple choice

Time to administer the MoCA is approximately 10 minutes.

© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB) 13

?ku dh ?kMhh cuk, ¼11 ctd

Contour Numbers Hands

ifj{k.k lQy jgs rc Hkh vka[k lkM+h eafnj xqykc uhyk No

Multiple choice cue

rkjh[k eghuk lky fnu txg ‘kgj

Table 4: Mean, SD, and percentiles of MoCA in Hindi

© Indian Council of Medical Research- Neurocognitive Tool Box (ICMR-NCTB)