Frequently Asked Questions

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

BoCA™ can be taken multiple times without artificial improvement in the scores (no practice effects) due to randomization of tasks on each administration. It provides scores that compare your performance to others your age and gender, which helps you understand how your cognitive abilities compare to what's typical for your age group.

BoCA™ is designed for adults 21 years of age and older. It is suitable for anyone who wants to understand their cognitive health, whether you are 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 core areas of cognitive function: memory, attention, language, problem-solving, math skills, visual-spatial abilities, orientation, and delayed recall. Each area is scientifically tested using specifically designed tasks that help identify strengths or potential areas of concern.

Yes, BoCA™ has been thoroughly tested and validated by researchers. Research shows that it measures cognitive abilities and impairments accurately and reliably. The BoCA™ is also an effective tool for longitudinal tracking of cognitive changes over time.

The BoCA™ has been validated in several key peer-reviewed studies that establish its reliability and correlation with "gold standard" cognitive assessments like the Montreal Cognitive Assessment (MoCA).

The BoCA™ test typically takes 8-12 minutes to complete. The test is 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.

BoCA™ is available in multiple languages, with the list continuing to grow:

• English
• Spanish
• French
• German
• Italian
• Portuguese (Brazil)
• Russian
• Chinese (Mandarin)
• Chinese (Cantonese)

Additional languages are added regularly to support diverse clinical, research, and personal use worldwide.

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

• Clinical indications such as memory concerns, cognitive impairment in various neurological conditions such as dementia, traumatic brain injury, multiple sclerosis, stroke and vascular cognitive impairment, Parkinson's Disease, or other neurodegenerative conditions. The assessment is also appropriate to evaluate cognitive symptoms or concerns related to medical issues such as cancer treatment side effects, post-COVID symptoms, post-anesthesia effects, and baseline establishment before medical interventions.
• Research applications include clinical trials, longitudinal aging studies, pharmacological research, and epidemiological studies.
• Proactive monitoring for individuals wanting baseline establishment and serial tracking over time.
• As part of a battery of tests included in a more in-depth evaluation, such as part of formal neuropsychological testing.

Cognitive assessments such as the BoCA™ have met rigorous psychometric standards to demonstrate validity including:

The BoCA™ has met reliability standards (internal consistency ≥0.70 for research, ≥0.80 for clinical use; stable test-retest reliability).

The BoCA™ has also met validation requirements such as correlation with gold-standard assessments, ability to distinguish impairment, standardized procedures, normative stratification, and peer-reviewed publication.

The BoCA™ demonstrates the reliability and validity of traditional paper-based tests but with the additional advantage of delivery in a flexible digital format. The digital delivery enables the user to take the test remotely and independently by personal tablet, smartphone, or computer.

Unlike a traditional paper-based test, the test can be easily taken without the support of a provider or clinician. The BoCA™ digital screen offers standardization, automated scoring, enhanced sensitivity, longitudinal testing and tracking capability, as well as additional behavioral data capture.

BoCA™ testing correlates highly with MoCA (R = 0.90, p < 0.001) results. In addition, the BoCA™ offers the following advantages that are not readily available with MoCA testing:

• Domain-specific measurement across 8 cognitive domains
• Age- and sex-normed results
• Longitudinal tracking with minimal practice effects
• Digital flexibility for remote or in-clinic use
• Population-scale monitoring and EHR integration
• Suitability for nonverbal or minimally verbal individuals

The MMSE has been the most widely used cognitive screening tool since 1975 and remains a common benchmark in clinical trials and research. BoCA™ is a clinically validated digital cognitive assessment that addresses several well-documented limitations of the MMSE:

Key Differences:

• Sensitivity to Mild Cognitive Impairment (MCI): The MMSE has well-documented ceiling effects - many individuals with early-stage cognitive decline score in the normal range (24-30), limiting early detection. BoCA™ measures 8 cognitive domains with greater granularity, providing more detailed data in the mild impairment range where clinical decisions are most critical.
• Domain-Specific Scoring: The MMSE has subsections (orientation, registration, attention, recall, language), but each contains too few items for reliable domain-level interpretation. BoCA™ provides psychometrically robust scores for each of 8 domains, enabling targeted clinical decisions about where changes are occurring.
• Age- & Sex-Normed Results: BoCA™ provides normative ranges adjusted for age and sex. While published age- and education-adjusted norms exist for the MMSE, it is commonly applied using a single cutoff score (typically 24), leading to both over- and under-identification across demographic groups.
• Repeat Testing: The MMSE uses fixed items susceptible to practice effects and memorization. BoCA™ uses randomized stimuli, enabling frequent longitudinal monitoring without learning effects (beta = 0.03, p = 0.68).
• Education & Language Bias: The MMSE relies on tasks with known education bias (spelling WORLD backwards, writing a sentence, following written commands), and is heavily dependent on verbal and written English proficiency. BoCA™ minimizes dependence on expressive language and education-dependent tasks, allowing more equitable assessment across diverse populations.
• Administration Format: The MMSE requires trained in-person administration and manual scoring. BoCA™ is self-administered digitally with automated scoring, reducing administrative burden and eliminating scorer variability.

When to Use Each: The MMSE remains commonly used for assessing moderate-to-severe cognitive impairment and is required by some clinical trial protocols. BoCA™ is designed for earlier detection, longitudinal monitoring, and population-scale screening where sensitivity to mild impairment, domain-level detail, and digital scalability are priorities.

BoCA™ is designed for use by Medical Doctors (MDs), Doctors of Osteopathic Medicine (DOs), Nurse Practitioners (NPs), Physician Assistants (PAs), and psychologists (PhDs, PsyDs). It is appropriate across clinical settings including primary care, geriatrics, neurology, and behavioral health.

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

BoCA™ supports reimbursable clinical workflows, including same-day administration alongside office visits. Reimbursement details vary by payer, specialty, and clinical context. Contact us for guidance on applicable CPT codes, billing workflows, and payer-specific considerations.

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.

Each BoCA™ report includes the patient's raw score, standard score, percentile ranking, a visual display of performance on a bell curve, and domain-specific results across 8 cognitive areas. For patients with multiple assessments, reports also include longitudinal trends showing changes over time.

Yes. BoCA™ is suitable for both initial cognitive screening and repeated longitudinal monitoring. Randomized stimuli minimize practice effects, making it reliable for serial assessments. Longitudinal data helps track treatment response, disease progression, and the effectiveness of lifestyle interventions.

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.

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." The ideal frequency depends on your individual needs and situation. Your healthcare provider can recommend a testing schedule tailored to 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 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

If you notice a meaningful change in your scores over time, or scores consistently below age-adjusted norms, discuss this 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:

• You notice a meaningful decline in your scores over time
• 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 may be at risk for conditions such as dementia and Alzheimer's disease, or other neurodegenerative and medical conditions. Always speak to your physician to help interpret significant new medical concerns or changes in your testing results.

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 changes over time, or download reports, you'll need to create an 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 for individuals today, with a limited number of assessments included. 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. The test includes audio-based prompts and instructions, which can support users with vision difficulties. BoCA™ also minimizes dependence on spoken responses, making it suitable for nonverbal or minimally verbal individuals.

If you have significant vision or hearing impairments, 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.