MoCA Delayed Recall — Questions and Answers
Question 1: How many words must the patient recall after the delay in the MoCA delayed recall task?
- 3 words
- 4 words
- 5 words (Correct answer)
- 7 words
Correct answer: 5 words
Five words are presented twice at the beginning of the MoCA. After a delay of approximately 5 minutes (during which other tasks are completed), the patient is asked to recall all 5 words freely.
Question 2: The five words used in the MoCA delayed recall task are presented how many times before the delay?
- Once
- Twice (Correct answer)
- Three times
- Four times
Correct answer: Twice
To allow encoding, the five words are read to the patient twice. The patient is told they will need to remember them later but is not asked to recall them immediately.
Question 3: In the MoCA, how long is the typical delay between initial word presentation and the delayed recall trial?
- 1 minute
- 5 minutes (Correct answer)
- 15 minutes
- 30 minutes
Correct answer: 5 minutes
Approximately 5 minutes pass between the initial word learning and the delayed recall test while other MoCA tasks (attention, language, abstraction, orientation) are administered.
Question 4: On the MoCA delayed recall task, if a patient cannot recall a word freely, what optional cue can be offered?
- The first letter of the word
- A category cue or multiple-choice options (Correct answer)
- The full word pronounced slowly
- No cues are ever allowed
Correct answer: A category cue or multiple-choice options
The MoCA allows optional category cues (e.g., "It was a type of flower") or multiple-choice cues for words not freely recalled. These optional cues do NOT earn full points but help determine if the failure is due to retrieval vs. encoding failure.
Question 5: What is the maximum score for the MoCA delayed recall domain?
- 3 points
- 4 points
- 5 points (Correct answer)
- 6 points
Correct answer: 5 points
The delayed recall section is worth 5 points — 1 point for each of the 5 words correctly recalled without any cueing. Words recalled only after a category or multiple-choice cue do not earn full points in standard scoring.
Question 6: Why does the MoCA test delayed recall rather than only immediate recall?
- To make the test longer
- Because delayed recall specifically tests memory consolidation, the hallmark of Alzheimer-type dementia (Correct answer)
- Because immediate recall is too easy for all patients
- Because delayed recall tests language ability
Correct answer: Because delayed recall specifically tests memory consolidation, the hallmark of Alzheimer-type dementia
Immediate recall reflects attention, but delayed recall tests the actual consolidation and retention of new information over time — the hallmark deficit in Alzheimer-type dementia.
Question 7: Which of the following best describes why optional cues in MoCA delayed recall do NOT earn full points?
- Because cues are too easy
- Because they distinguish encoding failure from retrieval failure (Correct answer)
- Because cues indicate cheating
- Because cued responses inflate the total score artificially
Correct answer: Because they distinguish encoding failure from retrieval failure
The distinction between free recall and cued recall is clinically important. Cuing a word that could not be freely recalled suggests retrieval difficulty rather than encoding failure, a different pattern of impairment.
Question 8: A patient recalls 3 of 5 words freely and retrieves 1 more word with a category cue. The standard MoCA delayed recall score is:
- 4 points
- 3 points (Correct answer)
- 2 points
- 3.5 points
Correct answer: 3 points
Standard MoCA scoring for the 5-point delayed recall domain counts only freely recalled words. Three freely recalled words = 3 points. The word retrieved via cue does not add to the 5-point total.
Question 9: The words used in the MoCA delayed recall section are typically drawn from which categories?
- Numbers and letters
- Abstract concepts and actions
- A person, a fabric, a building, a flower, and a color (Correct answer)
- Animals, foods, and occupations
Correct answer: A person, a fabric, a building, a flower, and a color
The standard MoCA v7.1 delayed recall words are: FACE, VELVET, CHURCH, DAISY, RED — spanning person, fabric, building, flower, and color categories to represent diverse semantic categories.
Question 10: Which type of dementia most characteristically shows impaired free recall with improved performance on multiple-choice cuing?
- Alzheimer's disease
- Subcortical dementias (e.g., vascular, Lewy body) (Correct answer)
- Frontotemporal dementia
- Creutzfeldt-Jakob disease
Correct answer: Subcortical dementias (e.g., vascular, Lewy body)
In subcortical dementias (e.g., vascular, Lewy body, Parkinson-related), the primary deficit is retrieval. Providing choices often significantly improves performance, distinguishing these from Alzheimer's where encoding itself is impaired.
Question 11: During the MoCA, when is the delayed recall task administered?
- Immediately after the word encoding trial
- After 30 minutes of a separate distractor task
- At the end of the MoCA, after all other tasks are completed (Correct answer)
- At the start, before other tasks
Correct answer: At the end of the MoCA, after all other tasks are completed
The delayed recall task is administered at the END of the MoCA, after the other domains have been tested. This ensures the delay time (approximately 5 minutes) has elapsed from the initial word presentation.
Question 12: A clinician notes a patient recalled 0 words freely but correctly identified all 5 words on multiple-choice. This most suggests:
- Severe global amnesia
- A retrieval deficit rather than a storage/encoding deficit (Correct answer)
- Malingering or poor effort
- Normal aging only
Correct answer: A retrieval deficit rather than a storage/encoding deficit
Intact recognition with failed free recall suggests a retrieval failure rather than storage/encoding failure, a pattern more consistent with subcortical or frontal pathology than Alzheimer's disease.
