MoCA Abstraction and Language 2 — Questions and Answers
Question 1: Which cognitive domain is the MoCA abstraction task primarily designed to assess?
- Visuospatial skills
- Executive function and conceptual reasoning (Correct answer)
- Episodic memory
- Sustained attention
Correct answer: Executive function and conceptual reasoning
Abstraction measures conceptual thinking, a component of executive function.
The similarities format used in the MoCA abstraction section evaluates the ability to think conceptually and form categories, which relies on frontal and executive networks. Poor abstraction with preserved memory can point toward frontal or subcortical processes rather than an amnestic condition. Along with verbal fluency and trail making, it contributes to the MoCA's executive assessment.
Question 2: What is the total number of points available across the MoCA language section (repetition and fluency)?
- 2
- 3 (Correct answer)
- 5
- 6
Correct answer: 3
Language includes sentence repetition (2 points) and verbal fluency (1 point) for a total of 3.
On the MoCA score sheet, the 'Language' section covers sentence repetition worth two points and phonemic verbal fluency worth one point, for three points in total. Animal naming (lion, rhinoceros, camel) is scored as its own three-point section and is not part of the language total.
Question 3: How should the examiner instruct the patient before reading the first repetition sentence on the MoCA?
- 'Listen and tell me what this sentence means'
- 'I am going to read you a sentence. Repeat it after me, exactly as I say it' (Correct answer)
- 'Read this sentence aloud from the card'
- 'Listen to this sentence and then say it backwards'
Correct answer: 'I am going to read you a sentence. Repeat it after me, exactly as I say it'
The patient is asked to repeat the sentence exactly as spoken.
The standard instruction is that the examiner will read a sentence and the patient should repeat it exactly. The sentence is read once, clearly, and the patient then responds. Following the first sentence, the examiner gives the second sentence with a similar instruction. This standardization ensures the task remains a test of language repetition and working memory.
Question 4: A patient answers the train-bicycle pair with 'you can ride both of them'. According to MoCA scoring guidance, how should this be treated?
- 0 points, because it does not mention transport
- 0 points, because it is a concrete action
- 1 point, since it captures the shared function of transport (Correct answer)
- 1 point, but only if the patient is prompted first
Correct answer: 1 point, since it captures the shared function of transport
Answers that capture the transport function, such as riding or travelling in both, are accepted.
MoCA guidance accepts responses for train-bicycle that convey the idea of transportation or travel, including 'means of transportation', 'means of travelling', or 'you take trips in both'. Saying you can ride both reflects their shared use for getting around and is generally scored as correct. In contrast, 'both have wheels' describes a physical feature and is not accepted.
Question 5: Why does the MoCA include both abstraction and sentence repetition, when the MMSE has only a single repetition item?
- To make the test longer for billing purposes
- To increase sensitivity to mild cognitive impairment, especially executive and language deficits (Correct answer)
- To test hearing more thoroughly
- To allow the test to be given without paper
Correct answer: To increase sensitivity to mild cognitive impairment, especially executive and language deficits
The MoCA adds executive and language items to detect milder impairment than the MMSE.
The MoCA was developed because the MMSE often misses mild cognitive impairment, particularly when executive function is affected. Adding a similarities task, longer and more complex sentence repetition, and phonemic fluency increases the test's sensitivity to subtle frontal and language deficits. This is one reason the MoCA is generally preferred for screening mild impairment.
Question 6: If a patient gives a concrete answer on the practice pair (banana-orange), what should the examiner do?
- Score the item zero and move on to the scored pairs
- Provide the abstract answer 'they are both fruit' and then continue (Correct answer)
- Skip the abstraction section entirely
- Give one more example before continuing
Correct answer: Provide the abstract answer 'they are both fruit' and then continue
The examiner supplies the correct abstract answer for the practice pair only.
The practice pair exists to teach the task. If the patient answers concretely, for example 'both have peels', the examiner says 'they are both fruit' and then proceeds to the scored pairs. No additional prompts or corrections are offered for train-bicycle or watch-ruler, and the practice pair itself is never scored.
MoCA Abstraction and Language 2
Which cognitive domain is the MoCA abstraction task primarily designed to assess?