MoCA - Montreal Cognitive Assessment — Questions and Answers

Question 1: According to standard MoCA scoring, which answer earns 1 point for the train/bicycle pair?

They are both made of steel
They are both fast
They are both means of transportation (Correct answer)
They are both found outdoors

Correct answer: They are both means of transportation

"They are both means of transportation" or "vehicles" correctly identifies the categorical relationship between a train and a bicycle, earning the full 1 point for that pair.

Question 2: How does Clock Drawing affect cognitive abilities?

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

Correct answer: It directly influences clock drawing and overall cognitive function.

This question assesses the importance of the skill in cognitive processes.

Question 3: How many individual subtraction attempts are made in the MoCA serial 7 task?

4 attempts
7 attempts
3 attempts
5 attempts (Correct answer)

Correct answer: 5 attempts

The examiner asks for 5 consecutive subtractions of 7 starting from 100 (93, 86, 79, 72, 65), giving 5 individual attempts to score.

Question 4: What does a score of 0 out of 3 on the MoCA naming section most likely suggest?

Test-taking anxiety without clinical significance
Superior cognitive reserve
Normal cognitive aging
Severe naming impairment requiring further evaluation (Correct answer)

Correct answer: Severe naming impairment requiring further evaluation

A score of 0/3 indicates severe difficulty with confrontation naming and warrants further neurological or neuropsychological evaluation.

Question 5: Which error type on MoCA sentence repetition is most commonly seen in patients with conduction aphasia?

Semantic paraphasias (substituting related words)
Perseverating the previous sentence
Complete silence
Phonemic paraphasias (substituting similar-sounding words) (Correct answer)

Correct answer: Phonemic paraphasias (substituting similar-sounding words)

Conduction aphasia characteristically produces phonemic paraphasias during repetition tasks.

Question 6: What impact does Abstract Thinking have on learning and memory?

It plays no role in learning or memory.
It enhances both learning and memory processes. (Correct answer)
It is not needed for memory retention.
It only affects motor learning.

Correct answer: It enhances both learning and memory processes.

Abstract thinking facilitates learning by allowing individuals to grasp complex concepts, make connections between disparate pieces of information, and form mental models. For memory, it helps organize information into meaningful categories, making it easier to encode, store, and retrieve. This deeper processing leads to more robust and flexible memory.

Question 7: For the MoCA place question, what response would be considered correct when the test is administered in an outpatient neurology clinic?

'A hospital'
'A clinic' or 'a doctor's office' (Correct answer)
'A school'
'A pharmacy'

Correct answer: 'A clinic' or 'a doctor's office'

The patient must correctly identify the type of setting; 'clinic' or 'doctor's office' accurately describes an outpatient neurology clinic.

Question 8: Which score on the MoCA Naming subtest (out of 3) is considered a perfect performance?

4
2
3 (Correct answer)
1

Correct answer: 3

A perfect score on the three-item Naming subtest is 3 points, one for each correctly named animal.

Question 9: How does Abstract Thinking influence problem-solving?

It has a negative impact on mental tasks.
It aids in effective problem-solving. (Correct answer)
It is irrelevant to solving complex tasks.
It hinders problem-solving abilities.

Correct answer: It aids in effective problem-solving.

Abstract thinking allows individuals to identify patterns, generalize from specific instances, and consider multiple perspectives when faced with a problem. This enables the development of creative solutions and the ability to strategize beyond immediate, concrete details. Without it, problem-solving would be limited to very literal and rigid approaches.

Question 10: What type of memory system is primarily assessed by the MoCA delayed word recall task?

Procedural memory
Semantic memory
Implicit memory
Episodic memory (Correct answer)

Correct answer: Episodic memory

Delayed word recall tests episodic memory — the ability to remember specific items from a recent personal experience.

Question 11: When a patient with moderate tremor draws a slightly irregular clock circle, the examiner should:

Disqualify the clock drawing task
Ask the patient to redraw more carefully
Score 0 for contour automatically
Award the contour point if it is recognizably a circle despite tremor (Correct answer)

Correct answer: Award the contour point if it is recognizably a circle despite tremor

Mild tremor or motor impairment that does not obscure the intent of the drawing is not penalized. The examiner should judge whether the overall intention is correct, not the neatness of execution.

Question 12: The MoCA cube is a two-dimensional line drawing of a three-dimensional shape. What term describes drawing a 3-D object on a flat surface?

Visual acuity
Object recognition
Spatial rotation
Visuoconstructive ability (Correct answer)

Correct answer: Visuoconstructive ability

Visuoconstructive ability refers to the capacity to reproduce a spatial structure, including representing 3-D objects on 2-D surfaces.

Question 13: If a MoCA patient answers the serial 7s as 93, 86, 79, 72, 65, what score do they receive?

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

Correct answer: 3 points

Scores of 3 correct = 3 points; all five correct = 3 points maximum since the scale caps at 3.

Question 14: When administering the MoCA Orientation questions, how should the examiner ask about the date?

Ask 'Can you tell me today's date, month, and year?' (Correct answer)
Skip the date question if the patient seems confused
Ask 'What year were you born?' to assess temporal orientation
Show the patient a calendar and ask them to point to today's date

Correct answer: Ask 'Can you tell me today's date, month, and year?'

The examiner verbally asks the patient to state the current date, month, and year without providing visual cues.

Question 15: Which of the following best describes the relationship between serial 7s performance and overall MoCA score in detecting mild cognitive impairment?

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

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 16: On the MoCA repetition task, sentences are read aloud and the patient must repeat them verbatim. How many sentences are presented?

3
2 (Correct answer)
4
1

Correct answer: 2

Two sentences of increasing grammatical complexity are read aloud, and the patient must repeat each one exactly for credit.

Question 17: What is the maximum score for the MoCA orientation domain?

6 points (Correct answer)
5 points
8 points
4 points

Correct answer: 6 points

There are 6 orientation items, each worth 1 point, for a total of 6 points. It is the second-largest domain on the MoCA after memory.

Question 18: 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 19: An examiner is about to administer the MoCA to a patient who is blind. How should the Orientation section be adapted?

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

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 20: On the MoCA, sentence repetition is worth a combined 2 points out of a total of how many points?

30 (Correct answer)
20
35
25

Correct answer: 30

The MoCA is scored out of 30 points total, with sentence repetition contributing 2.

Question 21: On the MoCA, a patient correctly taps only when hearing the letter 'A' in a random letter sequence read aloud. This task primarily assesses which executive function?

Response inhibition and sustained attention (Correct answer)
Lexical retrieval
Semantic memory
Prospective memory

Correct answer: Response inhibition and sustained attention

The vigilance task requires sustained attention and inhibiting the tap response for all non-target letters, testing response inhibition and sustained attention.

Question 22: How should a trained MoCA examiner respond if a patient volunteers one of the five target words during an intervening subtest?

Tell the patient to wait and repeat the word back to reinforce memory
Credit the word as recalled and move on
Immediately administer the Delayed Recall subtest
Acknowledge it neutrally but do not reward it as a Delayed Recall response (Correct answer)

Correct answer: Acknowledge it neutrally but do not reward it as a Delayed Recall response

The examiner should neither discourage nor specifically reward spontaneous mentions during other subtests; only responses given during the formal Delayed Recall prompt count toward the score.

Question 23: Earlier, I gave you a list of five words: "cat, sun, book, car, pen." <br> Now, I will ask you to recall those words after completing a short task. I want you to subtract 7 from 100 (and continue subtracting 7). After that, I will ask you to remember the list of words. <br> What are the words I asked you to recall earlier?

"cat, sun, book, car, pen" (Correct answer)
"pen, book, car, sun"
"book, car, sun, pen"
"sun, car, book"

Correct answer: "cat, sun, book, car, pen"

This question assesses delayed recall of the *second* word list ('cat, sun, book, car, pen') after an intervening task (serial 7s). The correct answer includes all five words from the list, demonstrating robust long-term memory retention despite interference. This task evaluates the participant's ability to retrieve specific information after a period of distraction, indicating strong memory encoding and retrieval processes.

Question 24: How does the cube copy task differ from the clock drawing task in what it primarily measures on the MoCA?

The cube copy is timed while clock drawing has no time limit
The cube copy is worth more points than clock drawing
The cube copy tests planning and temporal concepts while clock drawing tests spatial construction
The cube copy tests pure 3D visuoconstructional ability while clock drawing additionally requires executive planning and number knowledge (Correct answer)

Correct answer: The cube copy tests pure 3D visuoconstructional ability while clock drawing additionally requires executive planning and number knowledge

The cube copy is a relatively pure measure of visuoconstructional ability. Clock drawing additionally requires executive planning (setting the hands to a specified time), conceptual knowledge (clock face layout, numerals), and abstract representation — making it a richer multidomain task.

Question 25: Which of the following best explains why orientation is considered a 'global' cognitive function?

It is assessed identically in all cognitive screening tools
It is the only function that cannot be impaired in isolation
Orientation is exclusively dependent on the hippocampus
It requires simultaneous use of memory, attention, and contextual processing (Correct answer)

Correct answer: It requires simultaneous use of memory, attention, and contextual processing

Accurate orientation requires integrating memory, attention, and environmental context, making it a global cognitive marker.

Question 26: What is the relationship between Visuospatial Abilities and mental well-being?

It plays a crucial role in mental well-being. (Correct answer)
It is unrelated to cognitive health.
It only applies to physical well-being.
It has a detrimental impact on mental health.

Correct answer: It plays a crucial role in mental well-being.

Visuospatial abilities contribute to mental well-being by enabling individuals to interact effectively with their environment, maintain independence, and engage in meaningful activities. Difficulties in this area can lead to frustration, reduced confidence, and social isolation, thereby impacting overall mental health. Thus, it plays a crucial role in mental well-being.

Question 27: A patient scores 1 out of 3 on the MoCA serial 7s. How many of the five subtractions did the patient answer correctly?

None
Exactly 2 or 3
Exactly 1 (Correct answer)
Exactly 4 or 5

Correct answer: Exactly 1

MoCA scoring: 1 correct = 1 point, 2–3 correct = 2 points, 4–5 correct = 3 points.

Question 28: A researcher wants to use MoCA sentence repetition as an outcome measure in a clinical trial. What property makes it suitable?

It requires specialized equipment
It is only valid for patients over 75
It has established normative data and known sensitivity to cognitive decline (Correct answer)
It takes 10 minutes to administer

Correct answer: It has established normative data and known sensitivity to cognitive decline

Established norms and sensitivity to cognitive decline make sentence repetition a valid clinical trial outcome measure.

Question 29: On the MoCA cube copy task, what features must the copied cube demonstrate to earn 1 point?

It must be three-dimensional with parallel lines of approximately equal length (Correct answer)
Any closed three-dimensional shape is acceptable
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 30: The first MoCA sentence for repetition begins with 'I only know that John is the one...' — what does this sentence test alongside language?

Visuospatial construction
Naming ability
Abstract reasoning
Working memory and attention (Correct answer)

Correct answer: Working memory and attention

Sentence repetition also taxes working memory and auditory attention, not just language.

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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