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Occasionally, a formal battery of neuropsychological testing beyond the standard mental examination is needed to distinguish particularly mild cases of cognitive impairment from normal aging. In clinical practice, a careful history and results of a standard mental examination are often sufficient to make a diagnosis of MCI, and extensive cognitive testing is not routinely required. A score lower than 26/30 generally suggests cognitive impairment, especially in patients with 16 years of formal education. The Montreal Cognitive Assessment is a screening tool that is more sensitive than the Mini–Mental State Examination in the detection of MCI because it has more cognitively challenging tests of memory/recall and executive function. For most patients, the onset is insidious, and for some, the course may be progressive 10% to 15% of patients with MCI transition to dementia per year, compared with 1% to 2% per year of the general population. MCI is a cognitive state between normal aging and dementia characterized by a decline in cognitive functioning that is greater than what is expected with normal aging but has not resulted in significant functional disability. The most likely underlying cause of this patient’s symptoms is mild cognitive impairment (MCI). The correct answer is C: Mild cognitive impairment.

Moca scoring criteria