MoCA Clock Drawing 3 — Questions and Answers
Question 1: Which neurological condition is most classically associated with a 'closing-in' error on clock drawing, where the patient draws the clock directly on or crowded against the examiner's model?
- Frontotemporal dementia
- Alzheimer's disease (Correct answer)
- Parkinson's disease
- Normal-pressure hydrocephalus
Correct answer: Alzheimer's disease
Closing-in behavior during constructional tasks such as clock drawing is strongly associated with Alzheimer's disease.
Question 2: On the MoCA, the Clock Drawing numbers criterion requires numbers to be placed in which configuration to earn the point?
- Numbers 12, 3, 6, and 9 only must be present
- All 12 numbers present in correct sequence within the clock face (Correct answer)
- Numbers 1–12 present but spacing does not matter
- Only numbers 10, 11, and 12 must appear
Correct answer: All 12 numbers present in correct sequence within the clock face
The MoCA numbers criterion requires all 12 Arabic numerals present, in the correct sequence, and approximately correctly positioned inside the clock face.
Question 3: A patient with a left parietal lesion attempts clock drawing. Which type of error is most expected?
- Stimulus-pull placing hands on '10' and '11'
- Neglect of the right side of the clock face
- Neglect of the left side of the clock face (Correct answer)
- Perseverative repetition of the number 12
Correct answer: Neglect of the left side of the clock face
Left parietal lesions produce right hemispatial neglect, causing the patient to omit or crowd numbers on the right side of the clock.
Question 4: Which of the following clock drawing errors is most characteristic of executive dysfunction rather than visuospatial impairment?
- Gross distortion of the clock circle shape
- Numbers written outside the clock face due to poor spatial planning
- Placing hands on the numerals mentioned in the time verbally (stimulus pull) (Correct answer)
- Omitting numbers in the left quadrant of the clock
Correct answer: Placing hands on the numerals mentioned in the time verbally (stimulus pull)
Stimulus pull (pointing hands to the spoken numerals) reflects impaired inhibition and planning, hallmarks of executive dysfunction rather than purely spatial deficits.
Question 5: In MoCA scoring, what must be true about hand length to earn the hands point?
- Both hands must be drawn with arrows
- The minute hand must be longer than the hour hand
- Both hands must be present and pointing to the correct positions (Correct answer)
- The hands must be drawn with a ruler-straight line
Correct answer: Both hands must be present and pointing to the correct positions
The MoCA hands point requires both hands to be present and pointing approximately correctly to indicate 11:10; absolute length difference is not a scored criterion.
Question 6: A patient draws all 12 numbers but places them all on the right side of the clock face. Which scoring criterion is affected?
- Contour only
- Numbers only (Correct answer)
- Hands only
- Both numbers and hands
Correct answer: Numbers only
Crowding all numbers to one side violates the approximate correct position requirement for the numbers criterion.
Question 7: What is the rationale for including Clock Drawing in a brief cognitive screening tool like the MoCA?
- It is fast to administer and sensitive to mild cognitive impairment across multiple domains (Correct answer)
- It directly tests episodic memory, which is the earliest deficit in dementia
- It is the most reliable single predictor of Alzheimer's pathology
- It requires specialized drawing equipment unavailable in most offices
Correct answer: It is fast to administer and sensitive to mild cognitive impairment across multiple domains
Clock drawing is time-efficient and taps visuospatial, executive, and constructional abilities, making it a high-yield screen for MCI and early dementia.
MoCA Clock Drawing 3
Which neurological condition is most classically associated with a 'closing-in' error on clock drawing, where the patient draws the clock directly on or crowded against the examiner's model?