MoCA Executive Functioning 3 — Questions and Answers
Question 1: If a patient on the Trail Making B task connects 1-A-2-B-3-D (skipping C) but then self-corrects, how is this scored?
- Automatic failure — any error means 0 points
- 1 point — prompt self-correction is acceptable (Correct answer)
- 0 points — the examiner should not allow corrections
- 0.5 points for a partially correct sequence
Correct answer: 1 point — prompt self-correction is acceptable
On the MoCA, the examiner is instructed to point out errors immediately and allow the patient to self-correct without penalty, as long as the correction is made promptly. A successful self-correction does not automatically fail the trial.
Question 2: Which MoCA tasks fall under the Visuospatial/Executive domain?
- Trail Making B, cube copy, and clock drawing (Correct answer)
- Letter fluency, digit span, and abstraction
- Naming, sentence repetition, and fluency
- Delayed recall, orientation, and digit span
Correct answer: Trail Making B, cube copy, and clock drawing
The Visuospatial/Executive domain includes the Trail Making B task, the cube copy task, and the clock drawing task — all requiring spatial organization and/or executive planning.
Question 3: What does impaired performance on the MoCA executive tasks (Trail Making B, fluency) indicate clinically?
- Isolated language disorder (aphasia)
- Prefrontal-subcortical circuit dysfunction, seen in vascular or Parkinson's-related dementia (Correct answer)
- Severe medial temporal lobe amnesia
- Primary sensory cortex damage
Correct answer: Prefrontal-subcortical circuit dysfunction, seen in vascular or Parkinson's-related dementia
Poor executive functioning on the MoCA suggests dysfunction of prefrontal-subcortical circuits. This is common in vascular dementia, Parkinson's disease, and frontal lobe disorders.
Question 4: A patient earns 0 on Trail Making B, 0 on clock drawing, and 0 on letter fluency. What does this pattern suggest?
- A primarily amnestic (memory-dominant) disorder
- Broad executive dysfunction across multiple components (Correct answer)
- A pure visuospatial disorder
- Normal aging with fatigue during testing
Correct answer: Broad executive dysfunction across multiple components
Failure across all three executive domain tasks (Trail Making B, clock, fluency) indicates a broad executive impairment affecting cognitive flexibility, planning, and generative thinking.
Question 5: In the MoCA cube copy task, what does the examiner ask the patient to do?
- Draw a cube from memory
- Copy the provided three-dimensional cube drawing (Correct answer)
- Name the three-dimensional shape
- Rotate a cube mentally and describe it
Correct answer: Copy the provided three-dimensional cube drawing
The patient is asked to copy a line drawing of a three-dimensional cube. The copy must be three-dimensional and the lines roughly parallel and equal in length to earn 1 point.
Question 6: Why does the MoCA include a phonemic fluency task (letter F) in the executive section rather than a semantic fluency task (e.g., animal names)?
- Animal names are too easy for all patients
- Phonemic fluency more selectively taps frontal executive search strategies (Correct answer)
- Semantic fluency is tested elsewhere in the MoCA
- Phonemic fluency is harder to fake than semantic fluency
Correct answer: Phonemic fluency more selectively taps frontal executive search strategies
Phonemic fluency (letter F) relies more heavily on executive/frontal strategies for organized search, while semantic fluency (animal names) also reflects temporal lobe semantic memory. The MoCA emphasizes the executive component.
MoCA Executive Functioning 3
If a patient on the Trail Making B task connects 1-A-2-B-3-D (skipping C) but then self-corrects, how is this scored?