I Have to Pay to Use the Montreal Cognitive Assessment: What Should I Do?

Background: For many years, the Montreal Cognitive Assessment (MoCA) has been one of the most commonly used cognitive screening instruments in ambulatory care settings. Because the MoCA will no longer be in the free public domain by the end of 2020, it is important to consider cognitive screening tests that are comparable and free. Methods: We briefly review three cognitive screening instruments, the Saint Louis University Mental Status examination, the Short Test of Mental Status, and the Addenbrooke's cognitive examination, and compare these tests with the MoCA. Conclusion: The Addenbrooke's cognitive examination is a comprehensive cognitive examination that is too long for administration in primary care. The Short Test of Mental Status uses a 38-point scale, does not account for education, and is available only in English. The Saint Louis University Mental Status is an ideal candidate to replace the MoCA because similar to the MoCA, it is based on a 30-point scale and available in many languages. In addition to dementia, it has been validated for diagnosing mild cognitive impairment. While the MoCA has more tests suited for detecting dysexecutive dementias, it is possible to supplement the Saint Louis University Mental Status with comparable public domain executive function tests. In summary, we believe the Saint Louis University Mental Status to be a suitable free alternative to the MoCA.