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Low moca sits at the center of this dementia and brain health question.
Talking to your doctor about a low MoCA score starts with understanding what the score actually means—and what it doesn’t mean. A low MoCA (Montreal Cognitive Assessment) score doesn’t diagnose dementia or cognitive impairment on its own. Instead, it’s a screening tool that flags the possibility of cognitive changes and signals that further evaluation is needed. When you receive a score below 26 out of 30 points, the conversation with your doctor should focus on what happens next: additional testing, investigation into potential causes, and a plan for monitoring your cognitive health over time.
For example, if you score 23 points, your doctor won’t say “you have mild cognitive impairment”—they’ll say “this score suggests we need to look deeper into what might be affecting your thinking and memory.” The key to a productive conversation is going in prepared. You’ll want to know your exact score, understand what factors might have affected it on test day, discuss whether you’ve noticed actual changes in your daily life, and ask specifically about next steps. Many people feel anxious or confused after receiving results, but remember: a low MoCA score is the beginning of a diagnostic process, not the end of one. Your doctor’s job is to rule out treatable conditions, confirm whether cognitive impairment exists, and help you take action—whether that action is lifestyle changes, additional medical workups, or monitoring over time.
Table of Contents
- What Does Your MoCA Score Actually Tell Your Doctor?
- The Critical Difference Between Screening and Diagnosis
- When to Retest and What Practice Effects Mean
- Depression, Mood Disorders, and Misleading Low Scores
- The Medical Workup: Reversible Causes You Need to Rule Out
- Lifestyle Changes That Support Cognitive Health
- Setting Up a Monitoring Plan with Your Doctor
- Conclusion
What Does Your MoCA Score Actually Tell Your Doctor?
Your moca score falls into three basic categories. A score of 26 or higher is considered normal cognitive function. Scores between 18 and 25 fall into the mild cognitive impairment range—meaning the screening suggests possible cognitive changes, but additional testing is required before any diagnosis can be made. If you have 12 or fewer years of formal education, add 1 point to your total score when interpreting results, since education level affects performance on certain cognitive tests.
This adjustment exists because the test includes elements that depend partly on literacy and educational background, not just cognitive ability. Understanding these thresholds matters because they shape the conversation you’ll have with your doctor. If you scored 24, you’re in the range that suggests you need further investigation, but you’re not automatically being told you have a memory disorder. Your doctor will want to know: Did you score this way because of an actual cognitive change, or were there other factors at play? Were you stressed during the test? Depressed? Distracted? Did you get enough sleep the night before? These contextual factors significantly influence your score and should be discussed openly. A low MoCA score is a signal to investigate, not a verdict.
The Critical Difference Between Screening and Diagnosis
This is the most important thing to understand before meeting with your doctor: the MoCA is a screening tool, not a diagnostic test. A screening tool is designed to cast a wide net and identify people who might have a condition—but the screening itself cannot confirm the condition. Think of it like a blood pressure check at a pharmacy: if it reads high, that doesn’t diagnose hypertension, but it does tell you to see a cardiologist for further evaluation. Similarly, a low MoCA score tells your doctor to dig deeper, not to conclude you have mild cognitive impairment or dementia.
This distinction matters because many people leave their doctor’s office believing they’ve been “diagnosed with cognitive impairment” based on one low MoCA score, when in reality they’ve been flagged for further assessment. The actual diagnostic process is much more thorough. Your doctor will want to conduct or order additional cognitive testing, obtain a detailed medical history, run blood work to rule out reversible causes (like thyroid problems, vitamin deficiencies, or medication side effects), and gather information from family members or caregivers about whether they’ve actually noticed cognitive changes in your daily functioning. Only after this fuller evaluation can a real diagnosis be made. The MoCA is the starting point of that conversation, not the endpoint.
When to Retest and What Practice Effects Mean
If you scored low on your MoCA, your doctor will likely recommend retesting. Most clinical guidelines recommend waiting 4 to 6 weeks before repeating the test. This timing matters because of something called “practice effects”—if you retest too soon, you might score higher simply because you’re now familiar with the test, not because your cognitive function has actually improved. Taking the test again so quickly can give you and your doctor false reassurance. On the flip side, waiting too long between tests delays getting additional assessment if there really is a cognitive issue that needs attention.
The ideal scenario is a retest at the 4 to 6 week mark, combined with additional cognitive testing using different assessment tools. One low MoCA score in isolation is less reliable than multiple assessments or a combination of different cognitive tests. If you scored low the first time, ask your doctor about what type of additional testing they’d recommend. Some doctors use alternative cognitive assessments to cross-check the MoCA findings. Others refer to a neuropsychologist who can conduct a more comprehensive battery of cognitive tests in a controlled setting. This multi-pronged approach gives you and your doctor much clearer information about whether there’s actually a cognitive change happening.
Depression, Mood Disorders, and Misleading Low Scores
One of the most important contextual factors that can artificially lower your MoCA score is untreated depression. Research shows that major depression can reduce MoCA scores by 2 to 4 points—a significant drop that might push you from the normal range into the mild cognitive impairment range even though your actual cognitive capacity hasn’t changed. Depression affects concentration, motivation, processing speed, and memory recall, all of which are measured on the MoCA. If you’re depressed, you’re more likely to perform poorly on cognitive tests, but that poor performance reflects your mood state, not true cognitive decline. Before assuming a low MoCA score means cognitive impairment, tell your doctor if you’ve been feeling depressed, anxious, or emotionally overwhelmed.
This conversation is critical. If depression is the culprit, treating it might improve your MoCA score significantly without any cognitive intervention needed. Your doctor may recommend antidepressant medication, therapy, or both. Other mood-related conditions and high stress can also temporarily lower cognitive performance. Some people retest after addressing depression and find their scores return to normal—which tells them the original low score was a symptom of their mood disorder, not cognitive impairment. This is why your doctor should always screen for depression and other mental health factors before interpreting a low MoCA score as evidence of cognitive decline.
The Medical Workup: Reversible Causes You Need to Rule Out
After receiving a low MoCA score, your doctor should order a medical workup to identify potentially reversible causes of cognitive changes. Many conditions that seem like cognitive impairment can actually be treated or improved. Thyroid disease, vitamin B12 deficiency, vitamin D deficiency, medication side effects, sleep apnea, and hearing loss can all cause or contribute to cognitive difficulties. Some people assume they have dementia when they actually have hypothyroidism—and treating the thyroid disorder resolves the cognitive symptoms. The standard workup typically includes blood tests, assessment of your medications to see if any might be affecting cognition, and sometimes imaging like an MRI to rule out stroke, tumors, or other structural brain issues.
This is why the conversation with your doctor after a low MoCA score is so important. You need to understand what tests they’re ordering and why. A limitation of the MoCA itself is that it doesn’t tell your doctor which of these many conditions might be causing the low score—it only flags that something needs investigating. Your doctor’s job is to work through the most likely causes systematically. Ask specifically what’s being tested for and when you’ll have results. Ask what your doctor would do if tests reveal a treatable condition versus if they all come back normal.
Lifestyle Changes That Support Cognitive Health
Whether your MoCA score turns out to reflect true cognitive decline or reversible factors, your doctor will likely recommend evidence-based lifestyle changes. Aerobic exercise is one of the most powerful interventions. Aim for 150 minutes per week of moderate-intensity aerobic activity—that could be brisk walking, swimming, cycling, or any activity that gets your heart rate up. Studies have associated this amount of exercise with improved cognitive outcomes. You don’t need to become an athlete; a regular walking routine, dancing, or recreational sports count. Nutrition also matters significantly.
Research has found associations between improved cognitive outcomes and high intake of leafy greens (spinach, kale), berries (blueberries, strawberries), nuts, and olive oil. These foods are core to what’s often called the Mediterranean diet. You don’t have to make radical dietary changes overnight. Ask your doctor about starting with small, sustainable modifications—like adding berries to breakfast a few times a week, using olive oil more regularly, or increasing your intake of green vegetables. The advantage of focusing on lifestyle changes is that they benefit your overall health, not just your cognition. They can improve cardiovascular health, mood, sleep, and energy levels regardless of what your cognitive testing ultimately shows.
Setting Up a Monitoring Plan with Your Doctor
One outcome of the conversation about your low MoCA score should be a clear plan for ongoing monitoring. This might mean retesting at specific intervals, follow-up appointments after your medical workup is complete, or referral to a cognitive specialist. Ask your doctor explicitly: If my retest comes back normal, will we retest again in a year? In two years? If my medical workup shows something treatable, how will we monitor my cognitive function after treatment starts? What warning signs should I watch for? Having this plan in place removes some of the anxiety around the low score because you know what comes next. You’re not left wondering whether you should be worried or what happens now.
You have a roadmap. This also empowers you to notice any real changes in your daily functioning between appointments. Some people find it helpful to keep notes about their memory, focus, ability to manage finances or medications, or any other cognitive tasks that matter in their life. Bringing these observations to your follow-up appointment gives your doctor valuable information that complements the formal cognitive testing.
Conclusion
Receiving a low MoCA score can feel unsettling, but understanding what it actually means transforms the conversation with your doctor from anxiety-provoking to purposeful. Remember: the MoCA is a screening tool that signals the need for further evaluation, not a diagnosis in itself. Your score, combined with your medical history, mood state, lifestyle, and additional testing, will help your doctor understand what’s really going on with your cognitive health.
Go into the conversation prepared with your score, information about any health changes you’ve noticed, and a list of questions about next steps. The path forward typically includes repeat testing after 4 to 6 weeks, additional cognitive assessments, a medical workup to rule out reversible causes, and lifestyle changes that support brain health. Whether your low score reflects true cognitive impairment, a treatable medical condition, depression, or simply test-day factors, you’ll have a clear answer and a plan after moving through this evaluation process. That clarity and forward momentum are what matter most at this stage.
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For more, see Alzheimer’s Association — caregiving.
