BoCA | Cognitive Monitoring

Validation

BOCA has been validated in multiple studies. In one study, participants with cognitive disorders scored significantly lower in both the BOCA and Montreal Cognitive Assessment (MoCA) Test for Dementia compared to normal controls. In another study, participants with cognitive disorders scored significantly lower in both the BOCA and Telephone Interview for Cognitive Status (TICS) compared to normal controls. Correlational analyses revealed strong correlation between BOCA and Montreal Cognitive Assessment (r = 0.85, p < 0.01) and strong correlation with the Telephone Interview for Cognitive Status (r=0.80, p < 0.01). BOCA showed strong test-retest reliability of the total BOCA score one week after participants’ initial administration (r=0.89, p< 0.001).

1. Vyshedskiy, A., et al. Boston cognitive assessment (BOCA) — a comprehensive self-administered smartphone- and computer-based at-home test for longitudinal tracking of cognitive performance. BMC Neurol 22, 92 (2022). https://doi.org/10.1186/s12883-022-02620-6

2. Gold, D., et al. "The Boston cognitive assessment: Psychometric foundations of a self-administered measure of global cognition." The Clinical Neuropsychologist (2021): 1-18. https://doi.org/10.1080/13854046.2021.1933190

3. Ferguson, H., et al. “Preliminary Analysis of the Influence of Age and Education on the Boston Cognitive Assessment (BOCA).” Archives of Clinical Neuropsychology, 37 (6) 2022. https://doi.org/10.1093/arclin/acac060.303

For Researchers

Longitudinal monitoring is essential for testing novel interventions designed to reduce or reverse cognitive aging. BOCA is an invaluable tool for long-term cognitive monitoring. BOCA is an online instrument which evaluates global cognition through the completion of tasks spanning eight domains commonly included on other familiar screening instruments of global cognition (e.g., wordlist learning and delayed recall, repeating numerical sequences forward and backward, executive functioning, mental arithmetic, visuospatial reasoning, language and orientation). The BOCA uses randomly generated, non-repeating stimuli when assessing each domain, thereby enhancing its utility for serial assessment and long-term monitoring of cognitive status.

BOCA has the unique advantages of being automatically scored and utilizing random and non-repeating stimuli to reduce the risks of practice effects, which may be especially beneficial for research projects where cognitive tracking is required.

BOCA is currently utilized in dozens of clinical trials studying the effect of cognitive intervention, pharmaceutical treatment for Alzheimer’s disease, COVID fog, researching the effect of anesthesia and preoperative treatment, long-term effect of cancer drugs, as well as other interventional studies of Alzheimer’s disease and dementia.

BOCA is royalty free. Please email us if you are interested in using BOCA in your clinical studies.

For Clinicians

Many health care providers administering cognitive testing are using the MOCA or MMSE but are not getting paid for their work. BOCA provides rapid, mobile cognitive assessments and personalized cognitive care planning that are reimbursable. Clinical practices can use BOCA and get reimburses for CPT 96138, CPT 96132, and CPT 99483 for cognitive assessment administration and interpretation. Practices may also consider CPT 96116 as an alternative telehealth CPT code for cognitive testing. The BOCA test, combined with a few additional questions, can meet the requirements for CPT 96116.

Many treatable conditions such as sleep disorders, mood problems, heavy metal accumulation, as well as lack of movement and social interactions can affect memory and thinking. Longitudinal monitoring of cognitive health can help clinicians assess if an underlying condition is causing cognitive decline and guide timely therapeutic interventions. Standard cognitive assessments are not suited for monthly cognitive evaluations. First, they ubiquitously rely on trained professionals. While this approach has a high sensitivity and specificity for the detection of dementia, it is time and resource consuming. Second, the number of variations of standard tests is often limited resulting in strong practice effects. BOCA be performed at home using randomly-selected non-repeating tasks to minimize practice effects.

For Individuals

The Boston Cognitive Assessment (BOCA) is a self-administered and assisted online test intended for longitudinal cognitive monitoring. BOCA uses random never repeating tasks to minimize learning effects.

BOCA can be taken at the comfort of your home. It eliminates an extra visit to a psychometrician and saves about $300, usually not covered by insurance.

We recommend completing BOCA weekly, on the same day of the week, at the same time. After BOCA is completed, the domain scores and total score are provided immediately. Users will also receive an email with the link to the full report with progress charts.

BoCA Domains

BoCA evaluates eight cognitive domains. BoCA uses randomly-selected not-repeating tasks to minimize practice effects. The maximum total score is 30. Higher score indicates better cognitive performance.

1. Memory/Immediate Recall (Max. Score = 2)

The names of 5 animals are announced verbally. After a short pause, 10 buttons are displayed indicating the names of the 5 announced animals and 11 other random animals. The participant is expected to select the 5 announced animals. This subtest includes three attempts scored as follows: all five animals selected correctly on the 1st attempt: 2 points; all five animals selected correctly on the 2nd attempt: 1 point; otherwise zero points.

2. Language/Prefrontal Synthesis (Max. Score = 5)

Questions are announced verbally and the participant is expected to select the answer by pressing a picture on the screen.

Training: Integration of one modifier. E.g., ‘select the blue square,’ ‘select the green triangle.’
Level 1: Integration of one modifier. E.g., ‘select the blue square,’ ‘select the green triangle.’
Level 2: Integration of two modifiers. E.g., ‘select the large blue square,’ ‘select the small green triangle.’
Level 3: Spatial prepositions on top of and under. E.g., ‘select the square on top of the circle,’ ‘select the circle under the triangle.’
Level 4: Two object integration. E.g., ‘If the tiger was eaten by the lion, who is still alive?’; ‘If the boy was overtaken by the girl, who won?’
Level 5: Three objects integration. E.g., ‘The girl is taller than the boy. The monkey is taller than the girl. Who is the shortest?’

3. Visuospatial Reasoning/Mental rotation (Max. Score = 3)

The participant is expected to select the object, that, when rotated, is identical to the object on top.

Training: easy
Level 1: easy
Level 2: moderate
Level 3: challenging

4. Executive function/Clock test (Max. Score = 4)

The participant is expected to calculate the time difference between the two clocks.

Training: easy
Level 1: easy
Level 2: moderate
Level 3: challenging

5. Attention (Max. Score = 4)

The participant is instructed to click the announced digits in forward and backward order.

Training: Click the 4 digits in the order that you hear them
Level 1: Click the 4 digits in the order that you hear them
Level 2: Click the 5 digits in the order that you hear them
Level 3: Click the 3 digits in the backward order
Level 4: Click the 4 digits in the backward order

6. Mental math (Max. Score = 4)

The participant performs mental math by adding or subtracting two numbers.

Training: Single-digit number addition. E.g., 7+6=?
Level 1: Single-digit number addition. E.g., 7+6=?
Level 2: One-digit number plus two-digit number. E.g., 7+16=?
Level 3: Two-digit number plus two-digit number. E.g., 17+16=?
Level 4: Two-digit number minus two-digit number. E.g., 37-16=?

7. Orientation (Max. Score = 3)

The participant is expected to select today’s month, year, and day of the week.

Level 1: What month is it today?
Level 2: What year is it today?
Level 3: What day of the week is it today?

8. Memory / Delayed Recall (Max. Score = 5)

The participant is expected to select the five animals named at the beginning of the test. The score equals to the number of correctly named animals.

Boston Cognitive Assessment (BoCA)