MoCA - Montreal Cognitive Assessment — Questions and Answers

Question 1: What does poor performance on the MoCA cube copy task most directly indicate?

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

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 2: For clock hands to earn the MoCA hand placement point, they must:

Simply touch the correct numbers
Be the same length and point in approximately the right direction
Be drawn without any gap between them
Indicate 10 past 11 with the minute hand longer than the hour hand (Correct answer)

Correct answer: Indicate 10 past 11 with the minute hand longer than the hour hand

The hands must clearly indicate 10 past 11 (hour hand near 11, minute hand near 2) and the minute hand should be noticeably longer than the hour hand to earn the full point.

Question 3: Why is orientation important in cognitive assessments?

It is irrelevant to cognitive assessments.
It helps assess a person's ability to navigate and interact with the world. (Correct answer)
It only applies to specific individuals.
It has no impact on task performance.

Correct answer: It helps assess a person's ability to navigate and interact with the world.

Orientation is a foundational cognitive ability that reflects an individual's awareness of their surroundings and personal context. Assessing orientation provides insight into a person's basic cognitive processing, memory, and attention, which are crucial for independent functioning and safe interaction with their environment. Impairment in orientation can be an early sign of cognitive decline.

Question 4: What should the examiner do if a patient asks to see the cube model again during copying?

Remind the patient they saw the cube already
Show the model once more then remove it
Remove the model to test memory for the cube
Allow the patient to see the model as it remains visible throughout (Correct answer)

Correct answer: Allow the patient to see the model as it remains visible throughout

The stimulus cube remains visible throughout the copying task. It is not taken away from the patient. The patient should be encouraged to refer to the model as needed.

Question 5: A clinician notices a patient performs poorly on free recall but improves substantially with semantic cues on the MoCA. This pattern most suggests:

Encoding failure
Retrieval difficulty with intact storage (Correct answer)
Frontal lobe amnesia only
Complete hippocampal destruction

Correct answer: Retrieval difficulty with intact storage

Benefit from cueing indicates the information was encoded but retrieval cues are needed, pointing to a retrieval deficit.

Question 6: The MoCA naming subtest presents pictures in order of increasing difficulty. Which animal is considered the most difficult to name?

Camel
Lion
Rhinoceros (Correct answer)
All are equally difficult

Correct answer: Rhinoceros

The rhinoceros is considered the most demanding of the three naming items because it is the least frequently encountered and requires precise lexical retrieval.

Question 7: Serial 7 subtraction (starting from 100) is an alternate attention/executive task on the MoCA. Compared to phonemic fluency, serial 7s more specifically stresses which executive process?

Prospective memory
Semantic network access
Lexical retrieval speed
Mental arithmetic within working memory under time pressure (Correct answer)

Correct answer: Mental arithmetic within working memory under time pressure

Serial 7s require holding a running total in working memory while performing arithmetic operations sequentially, placing a distinct demand on numeric working memory under cognitive load.

Question 8: What is the purpose of assessing orientation to time in a cognitive evaluation?

It helps assess the individual’s awareness of current time. (Correct answer)
It is used to measure memory recall.
It has no relation to cognitive performance.
It is only relevant for physical health.

Correct answer: It helps assess the individual’s awareness of current time.

Assessing orientation to time in a cognitive evaluation like the MoCA is crucial because it directly measures an individual's awareness of their current temporal reality. This ability reflects their cognitive processing of time and their connection to the present moment. It helps determine if they are grounded in their surroundings and can track the passage of time effectively.

Question 9: Which patient population commonly shows deficits on the MoCA sentence repetition task even when other items are preserved?

Patients with isolated amnesia
Healthy older adults
Patients with primary progressive aphasia (Correct answer)
Patients with mild visuospatial decline only

Correct answer: Patients with primary progressive aphasia

Primary progressive aphasia often impairs sentence repetition while other cognitive domains remain relatively intact.

Question 10: How does MoCA abstraction performance typically compare between mild cognitive impairment (MCI) and normal cognition?

No difference exists between MCI and normal cognition
MCI affects memory only, not abstraction
MCI patients score higher due to compensation
MCI patients often score lower, reflecting early executive decline (Correct answer)

Correct answer: MCI patients often score lower, reflecting early executive decline

MCI frequently involves subtle executive deficits detectable on MoCA abstraction, making the subtest useful for distinguishing MCI from normal aging.

Question 11: A patient recalls the words FACE and RED spontaneously, then recalls CHURCH with a category cue, and cannot recall the remaining two even with multiple-choice. What is the formal MoCA memory score?

2 (Correct answer)
5
3
4

Correct answer: 2

Only FACE and RED were recalled spontaneously (no cue), earning 2 points; cued and unrecalled words add no points.

Question 12: How does the ability to recall the time of day help with cognitive assessment?

It is unrelated to cognitive function.
It is not necessary for cognitive assessments.
It is irrelevant to cognitive health.
It helps assess awareness and the ability to track time effectively. (Correct answer)

Correct answer: It helps assess awareness and the ability to track time effectively.

The ability to recall the time of day helps with cognitive assessment by evaluating an individual's immediate temporal awareness and their capacity to track time effectively within a shorter period. This skill is vital for daily scheduling, planning, and maintaining a sense of routine. It provides insight into their attention and short-term memory for current events.

Question 13: In the context of MoCA word recall, 'source monitoring failure' refers to:

Confusing the word list with pictures shown earlier
Reporting words from prior conversations as being on the list (Correct answer)
Forgetting where the test was administered
Inability to recall any words

Correct answer: Reporting words from prior conversations as being on the list

Source monitoring failure involves attributing a memory to the wrong origin, such as recalling words heard elsewhere as part of the list.

Question 14: How does Sentence Repetition relate to cognitive assessments?

It is essential for cognitive assessments related to memory and processing. (Correct answer)
It is only used for physical tasks.
It has no relevance to cognitive evaluations.
It is unnecessary for mental evaluations.

Correct answer: It is essential for cognitive assessments related to memory and processing.

Understanding how the subject fits into the overall cognitive assessment.

Question 15: On the MoCA score sheet, what information beyond total Delayed Recall points should the examiner record?

Whether the patient used a memory aid
Which words required a category cue and which required a multiple-choice cue (Correct answer)
The number of intrusion errors on other subtests
Patient's reaction time for each word

Correct answer: Which words required a category cue and which required a multiple-choice cue

The MoCA protocol instructs examiners to mark whether each word was recalled freely, with a category cue, or with a multiple-choice cue, providing a qualitative memory profile.

Question 16: How does calculation ability influence decision-making?

It helps individuals make informed decisions based on numerical data. (Correct answer)
It decreases the ability to make logical decisions.
It only applies to verbal decision-making.
It has no effect on decision-making.

Correct answer: It helps individuals make informed decisions based on numerical data.

Calculation ability is fundamental for effective decision-making, particularly when choices involve quantitative information such as finances, statistics, or measurements. It allows individuals to analyze data, compare options, and understand potential outcomes. Strong calculation skills lead to more rational and evidence-based decisions.

Question 17: The MoCA digit span forward sequence (21854) must be read by the examiner at which pace?

Two digits per second
One digit per second (Correct answer)
One digit every 2 seconds
As fast as comfortable

Correct answer: One digit per second

Standardized administration requires reading each digit at a rate of one per second.

Question 18: On the MoCA, subjects are told to remember the words for 'later.' What instruction is NOT given during encoding?

Read each word aloud
Try to memorize them
Recall them immediately after the list (Correct answer)
They will be asked to recall the words later

Correct answer: Recall them immediately after the list

Immediate recall of all words is not requested during the MoCA encoding phase; only delayed recall is formally scored.

Question 19: A patient who scores 0 on serial 7s but performs well on all other MoCA domains likely has difficulty with:

Language dysfunction
Selective arithmetic or sustained concentration difficulty (Correct answer)
Memory consolidation failure
Severe global dementia

Correct answer: Selective arithmetic or sustained concentration difficulty

Zero on serial 7s in isolation may indicate selective arithmetic difficulty, high test anxiety, or limited education rather than global cognitive impairment, especially when other domains are intact.

Question 20: On MoCA sentence repetition, a patient adds the word 'little' before 'cat' in the first sentence. How is this scored?

Full point if the rest is verbatim
Half point for partial accuracy
No point; additions count as errors (Correct answer)
Examiner may accept it as equivalent

Correct answer: No point; additions count as errors

Any addition to the sentence, even a small modifier, violates verbatim repetition requirements and results in no point for that sentence.

Question 21: What does impaired performance on the MoCA executive tasks (Trail Making B, fluency) indicate clinically?

Isolated language disorder (aphasia)
Severe medial temporal lobe amnesia
Primary sensory cortex damage
Prefrontal-subcortical circuit dysfunction, seen in vascular or Parkinson's-related dementia (Correct answer)

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 22: Sentence repetition on the MoCA falls under which cognitive domain?

Memory
Attention
Language (Correct answer)
Executive Function

Correct answer: Language

Sentence repetition is classified under the Language domain on the MoCA because it tests verbal processing, syntactic comprehension, and verbal working memory at the sentence level.

Question 23: A patient with mild cognitive impairment (MCI) most typically shows which pattern on the MoCA orientation section?

Complete disorientation to all 6 items
Preserved orientation combined with intact memory
Disorientation to place but intact time orientation
Orientation mostly preserved, with possible errors on exact date (Correct answer)

Correct answer: Orientation mostly preserved, with possible errors on exact date

In MCI, orientation is usually preserved or only minimally affected. The most sensitive MCI indicators on the MoCA are in the memory (delayed recall) and executive domains, not orientation.

Question 24: In the MoCA sustained attention task, the examiner reads a list of letters and the patient must tap whenever they hear which letter?

A (Correct answer)
S
T
E

Correct answer: A

The vigilance task requires the patient to tap each time the letter "A" is read aloud. It tests sustained attention and the ability to inhibit responses to non-target stimuli.

Question 25: How does the MoCA Orientation section differ from the MMSE Orientation section?

The MoCA asks more orientation questions than the MMSE
The MoCA asks fewer orientation questions than the MMSE (Correct answer)
Both tests ask identical orientation questions
The MoCA does not include an orientation section

Correct answer: The MoCA asks fewer orientation questions than the MMSE

The MMSE Orientation section has 10 items (5 time, 5 place), while the MoCA has only 6 orientation items.

Question 26: If a patient with left-sided hemispatial neglect draws a clock, which common pattern would be expected?

Numbers absent entirely
All numbers crowded on the right side of the clock face (Correct answer)
Hands missing from the drawing
All numbers crowded on the left side

Correct answer: All numbers crowded on the right side of the clock face

Patients with left neglect fail to attend to the left hemispace, so numbers are crowded or only present on the right half of the clock.

Question 27: On the MoCA cube copy task, what features must the copied cube demonstrate to earn 1 point?

Any closed three-dimensional shape is acceptable
It must be three-dimensional with parallel lines of approximately equal length (Correct answer)
It only needs to be closed and box-like
It must be perfectly proportioned to the model

Correct answer: It must be three-dimensional with parallel lines of approximately equal length

The cube copy earns 1 point if it is three-dimensional, has all parallel lines roughly parallel, and all sides are roughly equal in proportion. A flat two-dimensional square does not receive credit.

Question 28: What is the purpose of administering two immediate recall trials before the delayed recall in the MoCA?

To maximize initial encoding so delayed recall reflects true retention (Correct answer)
To tire the patient and make delayed recall more challenging
To score the immediate recall as part of the memory domain
Because one trial is not standardized

Correct answer: To maximize initial encoding so delayed recall reflects true retention

Two immediate recall trials maximize the initial encoding of the word list. Without adequate initial learning, a poor delayed recall score could reflect encoding opportunity rather than true retention failure.

Question 29: When scoring the backward digit span on the MoCA, the correct reversal of the sequence 7-4-2 is:

7-4-2
4-2-7
2-4-7 (Correct answer)
2-7-4

Correct answer: 2-4-7

The patient must repeat the digits in exact reverse order: 2-4-7.

Question 30: In the MoCA cube copy task, what does the examiner ask the patient to do?

Draw a cube from memory
Name the three-dimensional shape
Rotate a cube mentally and describe it
Copy the provided three-dimensional cube drawing (Correct answer)

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.

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%

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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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