Frequently Asked Questions

BoCA™ (Boston Cognitive Assessment) is a validated digital cognitive assessment that helps evaluate thinking and memory abilities. It's a 10-minute test that measures core cognitive functions.

BoCA™ uses randomized tasks on each administration, allowing repeat testing without practice effects. It provides scores that compare your performance to others your age and gender, helping you understand how your cognitive abilities measure up to what's typical for your age group.

BoCA™ is designed for adults 21 years of age and older. It's suitable for anyone who wants to understand their cognitive health, whether you're concerned about memory changes, want to establish a baseline, or are simply curious about your cognitive abilities. The assessment is also used by healthcare providers and researchers to evaluate cognitive function.

BoCA™ evaluates 8 important areas of cognitive function: memory, attention, language, problem-solving, math skills, visual-spatial abilities, orientation, and delayed recall. Each area is tested using scientifically designed tasks that help identify strengths and potential areas of concern.

Yes, BoCA™ has been thoroughly tested and validated by researchers. Multiple studies have shown that it measures cognitive abilities accurately and consistently.

Key findings from research studies:

• BoCA™ results closely match other well-established cognitive tests like MoCA and TICS (Telephone Interview for Cognitive Status)
• People with known cognitive problems score lower on BoCA™, confirming it can detect cognitive difficulties
• When people take BoCA™ multiple times, their scores remain consistent (showing it's reliable)
• Taking the test multiple times doesn't artificially improve scores (no practice effects)

These studies have been published in respected medical journals and reviewed by other scientists.

The BoCA™ test typically takes 8-12 minutes to complete. It's designed to be comprehensive enough to give meaningful results while being short enough to fit easily into your schedule. The exact time may vary slightly depending on how quickly you respond to the questions.

Cognitive testing is for everyone interested in their brain health — not just people experiencing problems. Just as you monitor blood pressure, cholesterol, or other health metrics, tracking cognitive function helps you stay informed about your brain health over time.

Common Reasons People Take BoCA™:

• Proactive health management: Establish a baseline and track cognitive health as part of overall wellness, just like regular checkups
• Peace of mind: Curious about cognitive abilities or wanting reassurance that memory and thinking skills are normal for your age
• Noticing subtle changes: Occasionally forgetting names, misplacing items more often, or taking longer to recall information
• Family history: Family members had dementia or Alzheimer's disease, and you want to monitor your own cognitive health
• Prevention focus: Research shows up to 45% of dementia cases may be preventable through lifestyle modifications — tracking helps you stay engaged in brain health
• Life transitions: Retirement, major life changes, or wanting to optimize cognitive function for work or hobbies
• Healthcare provider suggestion: Your doctor recommended cognitive assessment as part of routine care
• Spouse or family encouragement: Loved ones suggested testing, and you want to address their concerns

Why Regular Cognitive Testing Matters:

A single test provides a snapshot, but regular testing over months and years reveals meaningful patterns. Early detection of changes allows for timely intervention, whether through lifestyle modifications, medical evaluation, or preventive strategies. Many factors that affect cognition — including exercise, diet, sleep, social engagement, and stress management — are within your control.

Taking BoCA™ doesn't mean something is wrong. It means you're taking charge of your brain health, just as you would with any other aspect of wellness. The earlier you establish a baseline, the more valuable your long-term tracking becomes.

BoCA™ works on any device with an internet connection - smartphones, tablets, or computers. It's designed to work with all major web browsers, so you can use whatever device you're most comfortable with. The test works best on screens that are at least 4 inches wide.

Yes, you need an internet connection to access and complete the BoCA™ test. A standard internet connection (5 Mbps or faster) is recommended for the best experience, but it will work with slower connections too.

No preparation or studying is needed — BoCA™ measures your current cognitive abilities, not learned knowledge. However, to get the most accurate results:

Best Practices:

• Choose a quiet environment: Find a distraction-free space where you won't be interrupted
• Be well-rested: Take the test when you're alert, not when you're tired or sleepy
• Good lighting: Ensure you can see the screen clearly without straining your eyes
• Don't rush: Give yourself 15 minutes of uninterrupted time to complete the test comfortably
• Use headphones if available: Some test components include audio instructions

Avoid:

• Taking the test after consuming alcohol or recreational substances
• Testing when you're feeling unwell, extremely stressed, or emotionally distressed
• Multitasking during the test (watching TV, having conversations, etc.)

Remember: BoCA™ is designed to assess your natural cognitive abilities. Just relax and do your best!

BoCA™ is designed for repeat use. You can retake the test as often as you like — the tasks are randomized each time, so there is no "practice effect." For meaningful cognitive tracking, we recommend taking BoCA™ at least once per month. Your healthcare provider may suggest a different schedule based on your goals or medical history.

Don't worry if you are unsure which answer is correct! Almost everyone makes some errors during cognitive tests - it's completely normal. The test is designed to account for this, so just do your best and answer as accurately as you can. Occasional mistakes are part of normal cognitive function and won't significantly affect your overall results. If you think you can improve your score, feel free to re-take the BoCA™ test on another day.

Your results are available immediately after you finish the test. You'll see your scores, how you compare to others your age, and visual charts showing your performance across different cognitive areas. Your results are also saved securely so you can track changes over time if you take the test again.

After completing BoCA™, you'll receive your results immediately with detailed information about your cognitive performance. Here's what to expect:

Immediate Next Steps:

• Review your results: Look at your overall score and domain-specific performance across the eight cognitive areas tested
• Compare to age norms: See how your performance compares to others in your age and gender group
• Create an account (optional): Save your results for future tracking and comparison

Ongoing Monitoring:

• Track over time: Take BoCA™ regularly (monthly is recommended) to monitor changes in your cognitive health
• Look for patterns: A single test provides a snapshot, but tracking over time shows meaningful trends
• Share with your doctor: Export your results to discuss with healthcare providers during appointments

If You Have Concerns:

• If your score is lower than expected, consider factors that might have affected performance (fatigue, stress, distractions)
• Retest in a few days under optimal conditions to see if results are consistent
• If you notice a decline over multiple tests or have ongoing concerns, schedule an appointment with your healthcare provider

Remember: BoCA™ is an assessment tool, not a diagnosis. Your healthcare provider can perform comprehensive evaluation if concerns arise.

Your BoCA™ results help you understand how your thinking and memory abilities compare to others your age. Here's what the different scores tell you:

• Raw Score: Your actual score on the test
• Standard Score: How you compare to others your age and gender. A score of 100 is average, with most people scoring between 85 and 115
• Percentile: Your ranking compared to peers. For example, if you're in the 75th percentile, you scored better than 75% of people your age

Research shows that scores of 26 and above typically indicate normal cognitive function. However, these results should be discussed with a healthcare professional who can help interpret them in the context of your overall health.

Some cognitive changes are a normal part of aging, while others may signal a need for medical attention. Understanding the difference helps you interpret your BoCA™ results appropriately.

Normal Age-Related Changes:

• Processing speed: It may take slightly longer to complete mental tasks or recall information
• Word-finding: Occasional difficulty remembering names or specific words ("tip-of-the-tongue" moments)
• Divided attention: More challenging to multitask or focus when there are distractions
• Learning new information: May require more repetition or time to learn new skills

Why BoCA™ Uses Age-Adjusted Scores:

Because cognitive performance naturally changes with age, BoCA™ compares your results to others in your age group, not to young adults. This gives you a more accurate picture of whether your cognitive function is typical for your age or if there are concerning differences.

Changes That Warrant Attention:

• Getting lost in familiar places
• Difficulty managing finances or medications that were previously routine
• Forgetting important events or conversations shortly after they occur
• Difficulty following conversations or instructions
• Notable changes in judgment or decision-making
• Withdrawal from social activities due to cognitive concerns

A decline of 2 or more points on your BoCA™ score over a year, or scores consistently below age-adjusted norms, should be discussed with your healthcare provider. Early detection and intervention can make a meaningful difference in maintaining cognitive health.

If your BoCA™ score is lower than you expected, try not to worry — there are many reasons scores can vary, and a single test doesn't tell the whole story.

First, Consider These Common Factors:

• Sleep quality: Poor sleep the night before can significantly affect cognitive performance
• Stress or anxiety: Emotional distress can interfere with concentration and memory
• Medications: Some medications can temporarily affect mental clarity
• Illness: Being sick, even with a minor cold, can impact test performance
• Test environment: Distractions, poor lighting, or discomfort during the test
• Unfamiliarity with technology: First-time users may score lower simply due to the digital format

Recommended Next Steps:

1. Wait and retest: Take BoCA™ again in a few days when you're well-rested, in a quiet environment, and feeling your best. Scores often improve with optimal conditions.
2. Look for patterns: One low score isn't necessarily cause for alarm. Track your performance over several months to see if there's a consistent pattern or trend.
3. Review your lifestyle: Consider factors like sleep, exercise, diet, stress levels, and social engagement — all of which affect cognitive function.

When to Contact Your Healthcare Provider:

• Your scores decline by 2 or more points over the course of a year
• You consistently score below age-adjusted norms across multiple tests
• You or family members notice changes in daily functioning (managing finances, medications, cooking, or getting lost)
• You're experiencing memory problems that interfere with work or daily activities
• You have other symptoms like confusion, difficulty speaking, or changes in mood or personality

Remember: BoCA™ is an assessment tool, not a diagnostic test. Your doctor can perform a comprehensive evaluation, consider your medical history, and determine if further assessment is needed. Early evaluation is always better than waiting, and many conditions that affect cognition are treatable.

Individuals experiencing accelerated cognitive decline are at increased risk of developing dementia and Alzheimer's disease. Performance on a single cognitive test can be influenced by temporary factors such as sleep quality, mood, or overall health on the day of testing. In contrast, monitoring changes in cognitive scores across multiple assessments provides a more reliable picture of cognitive health over time, independent of one's intellectual baseline or daily fluctuations.

If your average score decreases by two or more points within a year, consult your physician.

You can take the BoCA™ test without creating an account, but your results will not be stored. If you want to view past scores, track monthly changes, or download reports, you'll need to create a free account.

You don't need an account to take the test, but you'll need one if you want your results saved and compared over time. The process depends on how you access BoCA™:

On the web trial:

1. Start and complete your first BoCA™ test.
2. On the results page, click "Create Account".
3. Enter your email address, choose a password, and confirm your email (check your inbox).
4. After verifying, you'll see your results dashboard. Your first result is saved and all future tests will be added automatically.

In the iOS app:

1. Visit boca.app to download the BoCA™ app from the App Store.
2. Take your first test in the app as guest.
3. After the test, tap "Sign Up" or "Create Account".
4. Provide your email, create a password, and optionally allow notifications.
5. Your results sync to your account and will be available whenever you log in.

Once your account is set up, you can:

• Access your past scores and track changes over time
• Retake the test anytime and see comparisons
• On the web: view/download your report
• On the app: see your score history and save to your profile

If you ever forget your password, use the "Forgot Password" link on the login screen to reset it.

No, BoCA™ is not a diagnostic test. It's designed to help identify potential cognitive changes that might need further evaluation. The results should be interpreted by qualified healthcare professionals who can consider your overall health, medical history, and other factors. BoCA™ is part of a comprehensive evaluation process, not a replacement for professional medical assessment.

Yes, you can easily share your results with healthcare providers. The detailed reports include all your scores, comparisons to age norms, and visual charts of your performance. Many healthcare professionals find these reports helpful for understanding your cognitive health and tracking changes over time. You can export and share these reports in a format that's easy for medical professionals to review.

BoCA™ is free to use today. It is also part of the Boston Cognitive Program, which offers optional paid features for people who want structured guidance beyond cognitive testing.

BoCA™ meets HIPAA privacy requirements and uses encrypted data storage. Your results are private, never shared without your permission, and you control access to your information.

BoCA™ is designed to be accessible, but some tasks may be challenging if you have significant vision or hearing impairments. The test primarily uses visual and touch interactions. If you have moderate vision difficulties, you may still be able to complete the test, but severe impairments could affect your results. We recommend discussing this with your healthcare provider to determine if cognitive testing is appropriate for your situation.

Our support team is here to help! You can reach us at [email protected]. We typically respond within 24 hours during business days. For urgent issues, please include "URGENT" in your email subject line. We can help with technical questions, account issues, and general questions about the BoCA™ test.

Cognitive assessment may be appropriate in various clinical and research contexts:

Clinical Indications:

• Concerns about memory, thinking, or cognitive changes
• Evaluation for possible mild cognitive impairment or dementia
• Following traumatic brain injury or stroke
• Monitoring effects of neurological conditions (e.g., Parkinson's disease, multiple sclerosis)
• Assessment of cognitive side effects from cancer treatment, anesthesia, or medications
• Post-COVID cognitive symptoms ("brain fog")
• Establishing cognitive baseline before anticipated medical interventions

Research Applications:

• Clinical trials evaluating interventions for cognitive decline
• Longitudinal studies tracking cognitive aging
• Studies of cognitive effects of pharmacological treatments
• Epidemiological research on cognitive health

Proactive Monitoring:

• Individuals concerned about cognitive health who want to establish a baseline
• Serial assessment over time to detect subtle changes
• Evaluation of lifestyle interventions aimed at cognitive preservation

Family physicians should consider referring patients to neuropsychologists when there are questions about diagnostic decision-making or planning of individualized management strategies for patients with cognitive concerns.

Cognitive assessments must meet rigorous psychometric standards to be considered scientifically valid:

Reliability Standards:

• Internal consistency: Reliability coefficients ≥0.70 are considered acceptable for research purposes, with ≥0.80 preferred for clinical applications
• Test-retest reliability: Scores should remain stable when individuals are tested multiple times under similar conditions

Validation Requirements:

• Correlation with established "gold standard" assessments
• Ability to distinguish between individuals with and without cognitive impairment
• Standardized administration procedures
• Normative data stratified by age, education, and demographic factors
• Peer-reviewed publication of validation studies

Recent systematic reviews indicate that the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) are among the most widely validated cognitive screening tools, with the MoCA showing particularly strong psychometric properties for detecting mild cognitive impairment.

Research indicates that digital cognitive assessments can be acceptably comparable to traditional paper-based tests, though important considerations exist:

Advantages of Digital Assessments:

• Standardization: More standardized administration without tester influence, reducing risk of bias
• Automated scoring: Eliminates scoring errors and provides immediate results
• Enhanced sensitivity: Can detect subtle cognitive deficits that may not be captured by paper-based procedures
• Serial testing capability: Facilitates frequent longitudinal monitoring to track changes over time
• Data collection: Captures reaction times and behavioral data not available in traditional testing

Important Considerations:

• Independent validation required: Digitizing a traditional test creates a new instrument that requires separate psychometric validation. High concordance is not guaranteed simply by converting pen-and-paper tests to digital format.
• Not automatically equivalent: Different test versions may involve partially different cognitive processes
• Equipment requirements: May require investment in hardware and technology infrastructure

Studies demonstrate that score equivalence can be achieved for many tests, with digital versions showing moderate to strong correlations with traditional versions. However, each digital assessment should be validated independently to ensure psychometric properties meet established standards.

MoCA is the gold standard screening tool, supported by 7,000+ peer-reviewed studies. BoCA™ builds on this foundation with strong correlation to MoCA (R = 0.90, p < 0.001) while extending its capabilities for modern clinical practice:

What BoCA™ Adds Beyond MoCA:

• Domain-Specific Measurement: While MoCA provides a single screening score, BoCA™ quantifies performance across 8 separate cognitive domains - revealing exactly where changes occur
• Longitudinal Tracking: Minimal practice effects (β = 0.03, p = 0.68) enable frequent serial testing - MoCA's practice effects limit repeated use
• Digital Flexibility: Administered by healthcare professionals in clinical settings or remotely when prescribed - no certification required
• Population Health Scale: Digital format enables efficient monitoring of large patient populations and integration with EHR systems

When to Use Each: MoCA excels at initial screening to identify whether cognitive impairment may be present. BoCA™ provides comprehensive assessment with quantitative domain-specific data - ideal for ongoing monitoring, tracking treatment response, research studies, and population health management.

Yes. BoCA™ is used by physicians, neuropsychologists, health systems, and remote-care programs.

BoCA™ can support billing under multiple CPT codes. Coverage varies by payer and clinical workflow.

Yes. BoCA™ offers provider dashboards, multi-patient management, and API/EHR integration.

Yes. BoCA™ offers API access and enterprise licensing for approved Health IT vendors. Visit platform.bostoncognitive.com for integration details.

Yes. BoCA™ is validated and has been used in peer-reviewed studies, longitudinal trials, and remote monitoring projects.

Yes. Researchers can export test results (CSV/JSON) for statistical analysis.