Evidence clearly supports the need to establish norms and cut-offs for the MoCA that are culturally appropriate and that are matched to the range of cognitive impairment that is present in the population being assessed. Nevertheless, content validity evidence suggests that the MoCA covers most of the domains that represent cognitive impairment in cerebrovascular disease, with mixed evidence for its preferential sensitivity to the type of cognitive impairment encountered in the context of vascular disease. Under-specification of the exclusion criteria applied and their impact make it difficult to assess the potential impact of sampling bias and loss to follow-up. Reporting of the methods and results of such studies tended to fall short of the established reporting guidelines. A total of 30 papers employing the MoCA in the context of cerebrovascular disease were identified. This paper presents a critical review of the research literature evaluating the validity and utility of this test with the aim of informing future clinical and research practice. The Montreal Cognitive Assessment (MoCA) has been suggested as a brief screening test of vascular cognitive impairment. Recognition and monitoring of mild cognitive impairment is thus essential to good patient care. Cognitive impairment is common among patients with stroke or other cerebrovascular disease and influences long-term outcome, including occupational functioning.
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