Creyos vs MoCA and Other Memory Screening Tests

If a doctor has mentioned "the MoCA" or a "memory screen," you may wonder how that compares with a computerized assessment such as Creyos. They answer different questions. The MoCA, MMSE, SLUMS and Mini-Cog are brief screening tools built to catch signs of dementia or mild cognitive impairment, usually in a primary care visit. Creyos is a longer computerized battery that measures several thinking skills and compares them with age norms. Neither one diagnoses dementia. Here is what each is for and what to do with a result.

Screens look for a problem; batteries describe a profile

A memory screen is built like a smoke detector. It is short, it gives a total score, and anyone below a set threshold is flagged for a closer look. That design is efficient for finding people who may have dementia or mild cognitive impairment (MCI), but it says little about people who score in the normal range or about which specific skills are strong or weak.

A computerized battery works more like a set of measuring tapes. Each task produces its own score, placed against age norms, so a clinician can see a profile. That is useful for working-age adults with concentration or memory complaints related to ADHD, depression, anxiety or sleep, where the question is rarely "is this dementia?" It is less suited to the quick office screening a primary care clinician does.

The four common screens at a glance

Each tool is copyrighted or licensed by its developers, and we do not reproduce their questions here. The MoCA's developers run an official training and certification program for clinicians who administer it. Cutoff scores vary by study, age, education and language, so a single number from one study should not be read as a pass mark.

What Creyos measures that a brief screen does not

Creyos (formerly Cambridge Brain Sciences) is a set of short online tasks, each scored against a database of more than 85,000 people and age bands that run up to 75 and older; the complete Creyos guide describes all 12. Scores are standard scores with an average of 100 and a standard deviation of 15, so a clinician can see whether you are below average (87 or lower, around the 20th percentile), average, or above average on each skill.

Creyos also has a protocol aimed at MCI and dementia, including a two-task screener (Number Ladder and Feature Match, about six minutes). The validation work behind it is early and was carried out by authors who include Creyos employees and a shareholder, so we would not treat it as an established dementia screen yet. Creyos is registered and listed with the FDA as a Class II, 510(k)-exempt computerized cognitive assessment aid; it is not FDA-cleared or approved and does not diagnose any condition.

One small independent study is worth knowing. In 2017, researchers gave the MoCA and two computerized Cambridge Brain Sciences tasks to 45 adults aged 65 and over. The computerized tasks added information beyond the MoCA and helped sort people with borderline MoCA scores. The authors' conclusion was to use the computerized tests together with standard tools like the MoCA, not instead of them.

Which screen a primary care clinician is likely to use

The U.S. Preventive Services Task Force (USPSTF) reviewed many brief instruments, including the MMSE, Mini-Cog, MoCA, SLUMS, clock drawing and informant questionnaires, and noted that most take five or ten minutes or less. Which one a practice uses usually comes down to time, training and familiarity.

Two points from federal guidance shape when screening happens:

• People without symptoms. For adults 65 and older living in the community who have no signs of cognitive problems, the USPSTF concluded in 2020 that the evidence is insufficient to weigh the benefits and harms of routine screening. That is an "I statement": neither for nor against.
• Medicare wellness visits. CMS requires clinicians to look for cognitive impairment during the Medicare Annual Wellness Visit, through direct observation and input from the patient and family. It does not mandate a particular test.

If you or your family have noticed changes, you are no longer in the "no symptoms" group. That calls for an evaluation, not just a screen. The USPSTF notes that a positive screen should lead to further testing, which can include blood tests, brain imaging, and medical and neuropsychological evaluation.

What a score on any screen can't tell you

Every test here measures performance on a particular day, and performance depends on more than brain health. Things that can lower a score include:

• Fewer years of formal education, or taking the test in a second language (the original Mini-Cog study found the MMSE was affected by both).
• Hearing or vision problems that make instructions or images hard to follow.
• Depression, anxiety and grief, which slow thinking and concentration.
• Short or poor sleep, pain, illness or a new medication.
• Unfamiliarity with computers, for a computerized battery like Creyos.

That is why the same result can mean different things for different people, and why the next step after an abnormal score is a conversation and a workup rather than a label. For older adults, medication is one of the most fixable causes; our guide to psychiatric medication in older adults explains which drugs geriatric experts flag for memory and confusion.

When to ask for a neurology or memory clinic referral

A primary care clinician is the usual first stop, and many will order labs and review medications before anything else. Ask about a referral to neurology or a specialist memory clinic when:

• a brief screen comes back abnormal, or a repeat screen shows decline;
• memory or thinking problems are getting steadily worse over months;
• daily tasks such as bills, medications, cooking or driving are becoming harder;
• changes started at a younger age than expected, or come with new movement, balance or personality changes.

Our page on when memory concerns need testing explains the differences between normal aging, depression-related changes and MCI in more detail.

Where a psychiatric provider fits

Mood, anxiety and sleep problems often travel with memory complaints, and they can be the main cause. MedlinePlus lists depression, bipolar disorder and the aftermath of major stress among the causes of memory loss, so the two are worth looking at together rather than one at a time. Our guide to depression and anxiety in later life covers how depression looks different in older adults.

Willow & Stone is a psychiatric practice, not a memory clinic, and does not do neuropsychological testing or diagnose dementia. Whether a visit with us is the right first step for a particular memory concern is something to ask our team before booking. For younger adults whose question is concentration, working memory or "brain fog," a computerized assessment can be one part of an evaluation; our look at free online cognitive tests explains how those differ from a clinician-reviewed assessment.

Common Questions

Sources & Further Reading

• Nasreddine et al. 2005, J Am Geriatr Soc — The Montreal Cognitive Assessment (PubMed)
• Tariq et al. 2006, Am J Geriatr Psychiatry — SLUMS vs MMSE (PubMed)
• Borson et al. 2000, Int J Geriatr Psychiatry — The Mini-Cog (PubMed)
• USPSTF — Cognitive Impairment in Older Adults: Screening (2020)
• Brenkel et al. 2017, Dement Geriatr Cogn Dis Extra — MoCA and a computerized battery (PubMed)
• MoCA Cognition — Training & Certification
• Creyos — Two-task cognitive screener validation study
• CMS — Cognitive Assessment & Care Plan Services

This article is general education, not a diagnosis or advice for your situation. Creyos results support, and never replace, a clinical evaluation; only a clinician who has evaluated you can diagnose a condition or recommend treatment. Do not start, stop, or change a medication without talking to the clinician who prescribes it.