Solid Review: The Romanian Version of the Montreal Cognitive Assessment (MoCA-Ro) Topic: Testul de Evaluare Cognitivă Montreal (MoCA) – Versiunea în limba română 1. Executive Summary The MoCA is a rapid screening tool for Mild Cognitive Impairment (MCI) and Alzheimer’s disease. The Romanian version (MoCA-Ro) has been formally adapted, validated, and is widely used in clinical and research settings across Romania and among Romanian-speaking populations (e.g., diaspora in Italy, Spain, Germany). It retains the original’s sensitivity (detecting real impairment) but requires attention to specific linguistic and cultural item adaptations. 2. Validity & Reliability (Evidence-Based)
Validation study: The official MoCA-Ro was validated on a Romanian cohort (e.g., studies by Tilea et al., or clinical teams at Romanian neuropsychiatric institutes). Cut-off scores (critical for interpretation):
≥ 26/30: Normal cognitive function. 18–25/30: Mild Cognitive Impairment (MCI) – this is where MoCA outperforms the MMSE. ≤ 17/30: Likely dementia. Note: Education adjustment (+1 point for ≤ 12 years of schooling) is applied in Romania as in the original.
3. Key Differences & Adaptations (Romanian Specifics) Unlike a direct translation, the MoCA-Ro modifies verbal tasks to fit Romanian linguistic structure: Moca Test Romana
Phonemic Fluency (“F” words → Romanian equivalent): Instead of “F” (rare in Romanian), the validated version uses ”M” or ”C” (e.g., cuvinte care încep cu “M” – măr, masă, munte ). Some clinical centers use “P” or “L”. Always note which letter is used. Alternating Trail Making: Unchanged (visuospatial, culturally neutral). Visuoconstruction (Cube & Clock): Unchanged. Verbal Memory (5-word list): Direct translation works well (e.g., față, catifea, biserică, crizantemă, roșu ). Sentence repetition: Adapted for Romanian syntax. E.g., ”Știu doar că Ion este cel care va ajuta astăzi.” (versus English “I only know that John is the one to help today.”) Abstraction (similarities): Culturally familiar pairs – e.g., banană – portocală (fruit), tren – bicicletă (means of transport).
4. Administration & Scoring – Critical Notes
Time: ~10-15 minutes. Language: Must be administered in Romanian by a fluent speaker. Switching to another language invalidates the norms. Trail Making B: The Romanian version uses the standard alphanumeric sequence (1-A-2-B…). Ensure patient knows letters in Latin alphabet (A, B, C). Clock drawing: Scoring includes contour, numbers, and hands (hands at 11:10 , not 10:10 as sometimes used in other cultures). Delayed recall: The 5-word list must be presented twice, then recalled after 5 minutes. Solid Review: The Romanian Version of the Montreal
5. Strengths (Why use MoCA-Ro?)
✅ High sensitivity for MCI – far superior to the Romanian MMSE (Mini-Mental). ✅ Validated norms for Romanian elderly (age 60+). ✅ Free for clinical use (official copy from www.mocatest.org, Romanian version available). ✅ Detects frontal/subcortical deficits (executive function, attention) better than MMSE.
6. Limitations & Cautions
❌ Education bias: Even with +1 point, poorly educated rural elderly (≤4 years of schooling) may falsely screen positive. In such cases, use the MoCA-Basic (adapted for low literacy) if available in Romanian. ❌ Cultural items: The animal naming (fluency) – acceptable animals in Romanian culture ( câine, pisică, vacă, cal ). Avoid exotic animals. ❌ Visual/hearing impairment: The trail making and cube copy require adequate vision. The verbal memory requires intact hearing. ❌ No substitute for full neuropsychological testing. MoCA is a screen, not a diagnosis.
7. Comparison to Other Romanian Cognitive Tests | Test | Target | Sensitivity for MCI | Time | Education level | |------|--------|---------------------|------|------------------| | MoCA-Ro | MCI, mild dementia | High (80-90%) | 10-15 min | ≥ 4 years | | MMSE-Ro | Moderate/severe dementia | Low | 5-10 min | Any | | RoCFT (Rey-Osterrieth) | Visuospatial/memory | Moderate | 20-30 min | Higher | | TMT (A & B) | Attention/executive | Moderate | 3-5 min | ≥ 8 years | 8. Practical Recommendation for Clinicians