For a cognitively healthy person over 70, a normal MoCA score generally falls between 23 and 30, depending on education level and other individual factors. The standard cutoff established by Dr. Ziad Nasreddine’s original validation study is 26 out of 30, but that threshold was developed using a younger sample and tends to misclassify many perfectly healthy older adults as cognitively impaired. If your parent scored a 24 on the MoCA and the doctor mentioned it was “below normal,” that does not necessarily mean anything is wrong — research increasingly shows that score is well within the expected range for someone in their seventies or eighties.
The Montreal Cognitive Assessment is scored on a 0 to 30 point scale and tests memory, attention, language, visuospatial ability, and executive function. It has become one of the most widely used cognitive screening tools in clinical practice. But the interpretation of scores is not as straightforward as a single number might suggest, especially for older adults. Many researchers now recommend a lower cutoff of 23 or 24 for people over 70, which provides better classification accuracy in this age group. This article breaks down what MoCA scores actually mean for older adults, why the standard cutoff may be too strict, how education and age affect results, and what to do if a score raises concern.
Table of Contents
- What Does a Normal MoCA Score Look Like for Someone Over 70?
- Why the Standard 26-Point Cutoff Is Too High for Older Adults
- How Education Level Shifts MoCA Scores
- What to Do If a Score Falls Below 23
- Common Factors That Can Temporarily Lower MoCA Scores
- How the MoCA Compares to Other Cognitive Screens
- Where MoCA Score Interpretation Is Headed
- Conclusion
- Frequently Asked Questions
What Does a Normal MoCA Score Look Like for Someone Over 70?
For community-dwelling older adults aged 70 and above, the median MoCA score is 26, with an interquartile range of 23 to 28 points. that means a full quarter of cognitively healthy older adults score below 23, and roughly half score below 26. Under the standard interpretation, many of those people would be flagged as having possible mild cognitive impairment — even though they are functioning just fine in their daily lives. A large five-country study called DO-HEALTH, which examined generally healthy adults age 70 and older, found mean scores that varied by subgroup and ranged from approximately 24 to 27 points.
This confirms what geriatric specialists have observed for years: the original 26-point cutoff was validated on a younger population, and applying it uniformly to older adults produces an unacceptably high rate of false positives. A 78-year-old retired teacher who scores 25 is not in the same clinical situation as a 55-year-old who scores 25, and the scoring should reflect that. The general scoring breakdown works like this: scores of 26 to 30 are considered normal under the original criteria, 18 to 25 may indicate mild cognitive impairment, and scores below 10 suggest severe cognitive impairment. But for adults over 70, those middle-range scores need far more context before anyone draws conclusions.
Why the Standard 26-Point Cutoff Is Too High for Older Adults
A 2015 study that established age- and education-adjusted norms for adults between 70 and 99 years old found that the standard cutoff of 26 is too stringent for this population. The study demonstrated that applying the 26-point threshold leads to high false-positive rates, meaning many healthy older adults get incorrectly labeled as having cognitive impairment. This finding has been replicated across multiple research groups and is now widely acknowledged in geriatric medicine. The MoCA has 90 percent sensitivity for detecting mild cognitive impairment and 100 percent sensitivity for Alzheimer’s disease at the 26-point cutoff. Those are impressive numbers.
However, sensitivity tells you how well a test catches true cases — it does not tell you how well it avoids false alarms. In older populations, the specificity drops considerably, meaning the test becomes much more likely to flag someone who is actually fine. This is a classic screening trade-off: casting a wider net catches more fish but also pulls in a lot of debris. If a clinician relies solely on the 26-point cutoff without considering age, a healthy 82-year-old with a score of 24 might be sent for expensive neuroimaging or referred to a memory clinic unnecessarily. That creates anxiety for patients and families, drives up healthcare costs, and can lead to a cascade of follow-up testing that was never warranted. This is why interpretation matters as much as the raw number.
How Education Level Shifts MoCA Scores
The official MoCA scoring protocol adds one point for individuals who have 12 or fewer years of formal education. This adjustment exists because education has a significant and well-documented effect on cognitive test performance. Research shows that age and education combined account for 26 to 49 percent of score variability in older adults. That is an enormous proportion — it means that nearly half of the difference between two people’s scores could be explained entirely by how old they are and how much schooling they completed. Consider two 75-year-old women. One has a master’s degree and worked as a university administrator.
The other left school after eighth grade and spent her career in manual labor. If both are cognitively healthy, the first woman might score 27 or 28, while the second might score 22 or 23. The one-point education adjustment does not come close to closing that gap. some clinicians and researchers argue the correction should be larger, but the official protocol has not changed. This education effect is not about intelligence. It reflects familiarity with test-taking, comfort with abstract reasoning tasks presented in a clinical setting, and years of practice with the types of cognitive skills the MoCA measures — things like drawing a cube, connecting dots in alphabetical and numerical order, or generating words that start with a particular letter. Someone who spent decades reading and writing reports will naturally perform differently on those tasks than someone whose work was primarily physical, regardless of their underlying cognitive health.
What to Do If a Score Falls Below 23
When a person over 70 scores below 22 on the MoCA, further clinical evaluation is warranted. That does not mean a diagnosis of dementia is inevitable — it means additional testing should be done to understand what is going on. A single screening score is never sufficient for diagnosis. The MoCA is a screening tool, not a diagnostic instrument, and there is an important difference between the two. A comprehensive cognitive evaluation typically includes a detailed medical history, neurological examination, blood work to rule out reversible causes like thyroid dysfunction or vitamin B12 deficiency, and often a more thorough neuropsychological battery that takes one to three hours. Some clinicians will also order brain imaging.
The goal is to distinguish between normal age-related cognitive changes, mild cognitive impairment that may or may not progress, and early-stage dementia that requires a care plan. The tradeoff families face is between acting early and avoiding unnecessary alarm. Pursuing evaluation after a low score can lead to early intervention, access to clinical trials, and better long-term planning. But it can also generate significant stress, especially if the outcome is ambiguous. Many people diagnosed with MCI never progress to dementia. The decision to pursue further testing should be a conversation between the patient, their family, and their physician — not an automatic response to a number on a screening form.
Common Factors That Can Temporarily Lower MoCA Scores
A MoCA score is a snapshot of cognitive performance on a single day, and many temporary factors can push that snapshot in the wrong direction. Sleep deprivation, medication side effects, anxiety about the test itself, depression, pain, dehydration, and even the time of day can all affect performance. A person tested at 8 a.m. after a poor night of sleep in an unfamiliar clinic may score several points lower than they would under better conditions. This is particularly relevant for older adults who are hospitalized or recovering from surgery.
Post-operative cognitive decline is common and usually temporary, but if a MoCA is administered during that recovery window, the score may look alarming. The same applies to people adjusting to new medications, especially anticholinergics, benzodiazepines, or opioids, all of which can impair cognitive test performance without reflecting any underlying neurodegenerative process. The limitation here is important to understand: a single low score should never be interpreted in isolation. If there is concern, the test should be repeated under better conditions, ideally after addressing any reversible factors. Serial testing over time — comparing scores from one visit to the next — provides far more useful clinical information than any individual result.
How the MoCA Compares to Other Cognitive Screens
The MoCA is not the only cognitive screening tool available. The Mini-Mental State Examination, or MMSE, was the standard for decades before the MoCA largely replaced it in many clinical settings. The MMSE is scored on a 30-point scale as well, but it is considered less sensitive to mild cognitive impairment — it tends to miss early-stage problems that the MoCA catches. For example, someone with early executive function decline might score perfectly on the MMSE but show deficits on the MoCA’s trail-making or clock-drawing tasks.
Other options include the Mini-Cog, which takes about three minutes and combines a clock-drawing task with a three-word recall, and the SLUMS examination developed at Saint Louis University. Each tool has different strengths and weaknesses, and clinicians choose based on the clinical question, the patient population, and the available time. The MoCA’s advantage is its sensitivity. Its disadvantage, as discussed, is that its standard cutoff over-identifies impairment in older and less-educated populations.
Where MoCA Score Interpretation Is Headed
The trend in cognitive screening is toward more nuanced, individualized interpretation. Researchers are developing population-specific norms that account for age, education, sex, and cultural background, rather than applying a single cutoff to everyone. Some groups are working on digital versions of the MoCA that could be administered remotely and scored with greater precision, potentially incorporating reaction time and error patterns alongside raw scores.
There is also growing recognition that cognitive screening should be part of routine preventive care for older adults, much like blood pressure or cholesterol checks. As more normative data accumulates for adults over 70, clinicians will be better equipped to tell the difference between a score that reflects normal aging and one that signals something that needs attention. Until those refined norms are fully integrated into clinical practice, the most important thing patients and families can do is make sure scores are interpreted by a qualified healthcare professional who considers the full picture — not just the number.
Conclusion
A normal MoCA score for someone over 70 is not as simple as “26 or above.” While that standard cutoff remains widely cited, research consistently shows that many cognitively healthy older adults score between 23 and 25, and that applying the 26-point threshold to this age group leads to unnecessary false positives. Education level, testing conditions, and individual baseline all play significant roles in determining what any particular score means. If you or a family member has received a MoCA score that falls in the 23 to 25 range, there is good reason to avoid panic.
Discuss the results with a healthcare professional who understands the limitations of the test in older populations, and ask whether age- and education-adjusted norms were considered. If the score is below 22, further evaluation is warranted but a low screening score is not a diagnosis. It is a starting point for a more thorough conversation about cognitive health and, if needed, a comprehensive assessment that accounts for the full clinical picture.
Frequently Asked Questions
Is a MoCA score of 24 bad for a 75-year-old?
Not necessarily. The median MoCA score for community-dwelling adults over 70 is 26, with an interquartile range of 23 to 28. A score of 24 falls well within the expected range for a cognitively healthy person in this age group, especially when education level is considered.
Should I worry if my parent scored below 26 on the MoCA?
The standard 26-point cutoff was validated on a younger sample and is considered too stringent for adults over 70. Many researchers now recommend a cutoff of 23 or 24 for this age group. A score of 23 to 25 alone is not cause for alarm, but it is worth discussing with a physician who can consider the full clinical context.
Does education affect MoCA scores?
Yes, significantly. Age and education combined account for 26 to 49 percent of score variability in older adults. The official protocol adds one point for individuals with 12 or fewer years of education, though some researchers believe this correction is insufficient.
How accurate is the MoCA at detecting dementia?
The MoCA has 90 percent sensitivity for mild cognitive impairment and 100 percent sensitivity for Alzheimer’s disease at the 26-point cutoff. However, its specificity is notably lower in older populations, meaning it is more likely to flag healthy older adults as impaired.
Can a MoCA score change from one test to the next?
Yes. Scores can be affected by sleep, medication, anxiety, depression, pain, and other temporary factors. A single score should not be over-interpreted. Serial testing over time gives a more reliable picture of cognitive trends.
What MoCA score indicates dementia?
There is no single score that definitively indicates dementia. Scores below 18 are generally associated with more significant cognitive impairment, and scores below 10 suggest severe impairment. However, the MoCA is a screening tool, not a diagnostic one. A formal diagnosis requires comprehensive clinical evaluation.
