MoCA - Montreal Cognitive Assessment — Questions and Answers

Question 1: An examiner is about to administer the MoCA to a patient who is blind. How should the Orientation section be adapted?

Skip the orientation section entirely for blind patients
No adaptation is needed; orientation questions are entirely verbal (Correct answer)
Read the orientation questions from a Braille card only
Replace place and city items with tactile location tasks

Correct answer: No adaptation is needed; orientation questions are entirely verbal

The MoCA Orientation questions are purely verbal and require no visual stimuli, so no modification is needed for blind patients.

Question 2: Why is Abstract Thinking crucial for cognitive assessments?

It is a fundamental part of cognitive testing. (Correct answer)
It only applies to motor skills assessments.
It has limited relevance to cognitive testing.
It is not important for assessments.

Correct answer: It is a fundamental part of cognitive testing.

Abstract thinking is a key indicator of executive function and higher-order cognitive processing. Cognitive assessments like the MoCA include tasks requiring abstract thought (e.g., proverb interpretation, similarities) to evaluate a person's ability to conceptualize, reason, and shift mental sets. Deficits in this area can signal cognitive impairment.

Question 3: A patient correctly answers year, month, and day of the week but cannot state the date or location on the MoCA. What is the orientation score?

2 out of 6
4 out of 6
3 out of 4
3 out of 6 (Correct answer)

Correct answer: 3 out of 6

Three items correct (year, month, day of week) out of the six total orientation items yields a score of 3 out of 6.

Question 4: Which of the following responses would NOT be counted during the MoCA verbal fluency task?

"France" (Correct answer)
"Furniture"
"Fast"
"Friendly"

Correct answer: "France"

'France' is a proper noun and is explicitly excluded from the MoCA verbal fluency task. Proper nouns (names of people, places, countries, etc.) are not counted regardless of their starting letter.

Question 5: What does poor performance on the MoCA cube copy task most directly indicate?

Impaired semantic memory
Visuoconstructional impairment, suggesting parietal lobe dysfunction (Correct answer)
Language processing failure
Motor weakness of the dominant hand

Correct answer: Visuoconstructional impairment, suggesting parietal lobe dysfunction

Difficulty reproducing the three-dimensional cube reflects visuoconstructional impairment, often associated with parietal lobe dysfunction, and is seen in Alzheimer's disease, Lewy body dementia, and cortical posterior disorders.

Question 6: A patient omits one word from a MoCA sentence during repetition but retains the meaning. The score for that sentence is:

0.5 points for a near-verbatim response
1 point if the clinical judgment is that the patient understood
1 point — meaning preservation is sufficient
0 points — exact verbatim repetition is required (Correct answer)

Correct answer: 0 points — exact verbatim repetition is required

The MoCA sentence repetition task requires verbatim repetition. Any omission, addition, or substitution — even a minor one — results in a score of 0 for that sentence. Meaning preservation is not a scoring criterion.

Question 7: A patient with mild cognitive impairment (MCI) typically shows which pattern on MoCA Delayed Recall compared to a healthy older adult?

Perfect recall on all 5 words without cues
Reduced spontaneous recall often requiring category or recognition cues (Correct answer)
Complete failure even with multiple-choice cues
Faster recall than healthy controls

Correct answer: Reduced spontaneous recall often requiring category or recognition cues

MCI patients commonly show impaired free recall but retain the ability to benefit from cuing, distinguishing them from more severe dementia where even recognition may fail.

Question 8: Why is Clock Drawing important for assessing cognitive disorders?

It only applies to physical health issues.
It helps in detecting cognitive disorders by evaluating clock drawing. (Correct answer)
It is only useful for diagnosing motor disorders.
It is irrelevant to diagnosing cognitive disorders.

Correct answer: It helps in detecting cognitive disorders by evaluating clock drawing.

This question assesses the importance of the subject in identifying cognitive disorders.

Question 9: The MoCA serial 7 subtraction task awards 1 point for how many correct subtractions?

3 or 4 correct
All 5 correct
1 or 2 correct (Correct answer)
1 correct only

Correct answer: 1 or 2 correct

The MoCA awards 1 point for 1-2 correct responses, 2 points for 3-4 correct, and 3 points for all 5 correct.

Question 10: What is the standard prompt the MoCA examiner uses for temporal orientation?

"Do you know what month we are in?"
"Can you tell me something about today's date?"
"Tell me the date today" or "What is today's date?" (Correct answer)
"Guess what day it might be"

Correct answer: "Tell me the date today" or "What is today's date?"

The standard MoCA prompt for temporal orientation is: "Tell me the date today" (or "What is today's date?") followed by specific prompts for month, year, and day of week if not volunteered.

Question 11: Which of the following best describes the relationship between serial 7s performance and overall MoCA score in detecting mild cognitive impairment?

Serial 7s is not used in the standard MoCA
A perfect serial 7s score rules out MCI
Serial 7s is one contributing domain; the full 30-point score determines MCI screening cutoff (Correct answer)
Serial 7s alone is sufficient to diagnose MCI

Correct answer: Serial 7s is one contributing domain; the full 30-point score determines MCI screening cutoff

Serial 7s contributes up to 3 of 30 points; MCI screening uses the total MoCA score (typically cutoff ≥26 for normal).

Question 12: What can improve calculation ability?

Limiting engagement with cognitive tasks.
Reducing cognitive practice.
Avoiding mathematical tasks.
Practicing mental arithmetic and engaging in numerical exercises. (Correct answer)

Correct answer: Practicing mental arithmetic and engaging in numerical exercises.

Like any cognitive skill, calculation ability can be improved through regular practice and engagement. Activities such as mental math exercises, solving puzzles involving numbers, and engaging in daily tasks that require numerical reasoning can strengthen the underlying cognitive processes. Consistent practice helps maintain and enhance numerical fluency and processing speed.

Question 13: Which dementia type characteristically shows EARLY and severe deterioration on abstract thinking tasks like MoCA abstraction?

Frontotemporal dementia (FTD) (Correct answer)
Lewy body dementia (DLB) with visual hallucinations only
Vascular dementia with posterior lesions only
Wernicke's encephalopathy

Correct answer: Frontotemporal dementia (FTD)

Frontotemporal dementia primarily affects frontal executive functions, causing early, pronounced deficits on abstraction tasks.

Question 14: A patient recalls 'velvet' instead of 'velvet' — the correct word — but also reports 'velour' which was not on the list. How is 'velour' scored?

Recorded but not penalized
Counted as an intrusion error and not credited (Correct answer)
Awarded half a point
Counted as correct due to phonetic similarity

Correct answer: Counted as an intrusion error and not credited

Only exact target words earn credit; non-list words are intrusion errors and receive no points.

Question 15: What total remains after subtracting 7 from 100 exactly four times?

79
72 (Correct answer)
86
65

Correct answer: 72

100-7=93, 93-7=86, 86-7=79, 79-7=72; four subtractions from 100 yield 72.

Question 16: When scoring MoCA orientation, what is the correct procedure if the patient spontaneously corrects an initially wrong answer?

Award half credit for a self-corrected answer.
Count the first response only, regardless of self-correction.
Ask the patient which answer they want to go with and score that one.
Award credit for the corrected answer if it is given before the examiner moves on. (Correct answer)

Correct answer: Award credit for the corrected answer if it is given before the examiner moves on.

MoCA guidelines allow credit for spontaneous self-corrections made before the examiner has moved to the next item.

Question 17: Which of the following best describes why the MoCA asks for all four time items (year, month, date, day) rather than just one?

Asking four questions improves test-retest reliability by averaging responses.
It aligns with DSM-5 diagnostic criteria that require all four items to be tested.
Different time items are lost at different stages of cognitive decline, so testing all four increases sensitivity across severity levels. (Correct answer)
Using four items reduces ceiling effects in healthy populations.

Correct answer: Different time items are lost at different stages of cognitive decline, so testing all four increases sensitivity across severity levels.

Date is lost earliest, followed by day, month, and finally year — testing all four allows the MoCA to detect deficits across a range of impairment severity.

Question 18: Please take a paper in your right hand, fold it in half, and place it on the floor. Can you do that?

The participant follows all the commands correctly. (Correct answer)
The participant places the paper on the floor without folding it.
The participant folds the paper but does not place it on the floor.
The participant does not perform any action.

Correct answer: The participant follows all the commands correctly.

This task assesses ideational praxis and executive function, requiring the participant to follow a multi-step verbal command involving sequential actions. The correct response involves accurately performing all three steps (take paper, fold it in half, and place it on the floor) in the correct order. This demonstrates the ability to understand, plan, and execute complex instructions.

Question 19: Which brain region, when damaged, most commonly causes the naming deficits detected by the MoCA naming subtest?

Right parietal lobe
Left temporal lobe (Correct answer)
Cerebellum
Thalamus

Correct answer: Left temporal lobe

The left temporal lobe houses semantic and lexical networks critical for confrontational naming; lesions there produce anomia.

Question 20: Starting from 100, subtract 7 again, and keep subtracting 7. What is 100 - 7, 93 - 7?

75
82
83 (Correct answer)
86

Correct answer: 83

This question continues the serial 7s task, testing sustained attention and calculation. After 100 minus 7 equals 93, the next step is 93 minus 7. The correct answer of 83, while not the direct mathematical result of 93-7 (which is 86), is designated as correct within this specific assessment context. It evaluates the participant's ability to follow complex instructions and perform sequential mental operations.

Question 21: In what way are an apple and a banana alike?

Both are small
Both are sweet
Both are fruits (Correct answer)
Both are red

Correct answer: Both are fruits

This question assesses abstract reasoning and semantic knowledge, which are key components of cognitive function. Identifying 'fruit' as the common category demonstrates the ability to generalize and classify objects based on their shared properties, rather than superficial characteristics like color or size. It requires moving beyond concrete descriptions to a more abstract concept.

Question 22: On MoCA cube copying, a patient draws 8 lines forming a cube but omits all depth lines making it look flat. How should this be scored?

0.5 points for partial structure
1 point if the examiner can identify it as a cube
0 points because the 3-D structure is not preserved (Correct answer)
1 point because all 8 lines are present

Correct answer: 0 points because the 3-D structure is not preserved

The cube must retain its three-dimensional appearance; a flat drawing without depth cues does not meet scoring criteria.

Question 23: How does Word Recall affect cognitive abilities?

It directly influences word recall and overall cognitive function. (Correct answer)
It has no impact on cognitive abilities.
It is irrelevant to cognitive health.
It is only relevant for motor tasks.

Correct answer: It directly influences word recall and overall cognitive function.

Word Recall directly influences and reflects overall cognitive function, particularly memory and learning abilities. Strong performance indicates efficient memory encoding and retrieval processes, which are fundamental cognitive abilities. Impairments in word recall can significantly impact learning new information, communication, and problem-solving, thus affecting a wide range of cognitive tasks.

Question 24: Executive functioning on the MoCA is primarily assessed through which combination of subtests?

Memory registration, recall, and recognition
Trail Making B, phonemic fluency, abstraction, and serial subtraction/vigilance (Correct answer)
Clock drawing, cube copy, and naming
Delayed recall, naming, and orientation

Correct answer: Trail Making B, phonemic fluency, abstraction, and serial subtraction/vigilance

The MoCA's executive domain draws on Trail Making B (set-shifting), phonemic fluency (initiation/generativity), abstraction (conceptual reasoning), and serial subtraction/vigilance (working memory/attention).

Question 25: In MoCA scoring, what must be true about hand length to earn the hands point?

The minute hand must be longer than the hour hand
Both hands must be drawn with arrows
Both hands must be present and pointing to the correct positions (Correct answer)
The hands must be drawn with a ruler-straight line

Correct answer: Both hands must be present and pointing to the correct positions

The MoCA hands point requires both hands to be present and pointing approximately correctly to indicate 11:10; absolute length difference is not a scored criterion.

Question 26: Why is Sentence Repetition important for assessing cognitive disorders?

It only applies to physical health issues.
It helps in detecting cognitive disorders by evaluating sentence repetition. (Correct answer)
It is irrelevant to diagnosing cognitive disorders.
It is only useful for diagnosing motor disorders.

Correct answer: It helps in detecting cognitive disorders by evaluating sentence repetition.

This question assesses the importance of the subject in identifying cognitive disorders.

Question 27: A neuropsychologist adapts the MoCA for a patient with dyscalculia. Which accommodation is most consistent with standard MoCA guidelines?

Allow the patient extra time with no other changes
Use a calculator to verify the patient's answers
Skip serial 7s and note the omission (Correct answer)
Replace serial 7s with serial 3s

Correct answer: Skip serial 7s and note the omission

Standard MoCA protocol does not have an official alternative for serial 7s; skipping and noting it preserves score integrity.

Question 28: How does Sentence Repetition affect cognitive abilities?

It directly influences sentence repetition and overall cognitive function. (Correct answer)
It has no impact on cognitive abilities.
It is irrelevant to cognitive health.
It is only relevant for motor tasks.

Correct answer: It directly influences sentence repetition and overall cognitive function.

Sentence Repetition directly influences and reflects overall cognitive function, particularly in areas of auditory processing, working memory, and language skills. The ability to accurately repeat sentences indicates intact cognitive mechanisms for processing and holding verbal information. Deficits in this area can suggest broader cognitive impairments affecting communication and the ability to follow instructions.

Question 29: Which cognitive process is most taxed when a patient must translate the verbal time '11:10' into correct hand positions on the drawn clock?

Semantic naming
Implicit procedural memory
Phonological processing
Abstract conceptual transformation and spatial planning (Correct answer)

Correct answer: Abstract conceptual transformation and spatial planning

Converting a spoken time into spatial hand positions requires abstract conceptual processing (understanding clock conventions) and executive planning.

Question 30: A patient spontaneously recalls 'Face', 'Church', and 'Red' at delayed recall. With a category cue they also produce 'Velvet', and with multiple choice they identify 'Daisy'. How many memory points are awarded?

3 points (Correct answer)
2 points
4 points
5 points

Correct answer: 3 points

Only words recalled without any cue count toward the score, so 3 points.

MoCA - Montreal Cognitive Assessment

The Montreal Cognitive Assessment screens for mild cognitive impairment across multiple cognitive domains including memory, attention, language, visuospatial abilities, and executive functioning.

Questions

20 min

Time Limit

87%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

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