MoCA Executive Functioning 2 — Questions and Answers
Question 1: On the MoCA Trail Making B task, a patient connects numbers and letters in this order: 1-A-2-B-3-C. What cognitive ability does this primarily test?
- Pure motor speed
- Cognitive set-shifting and mental flexibility (Correct answer)
- Visual acuity
- Long-term memory recall
Correct answer: Cognitive set-shifting and mental flexibility
Trail Making B requires the patient to alternate between number and letter sequences, directly assessing cognitive set-shifting, a core executive function.
Question 2: A patient scores 0 on the MoCA phonemic fluency task (words beginning with 'F'). Which threshold determines full credit?
- 5 or more words
- 8 or more words
- 11 or more words (Correct answer)
- 15 or more words
Correct answer: 11 or more words
The MoCA awards 1 point for generating 11 or more words beginning with the letter 'F' within 60 seconds.
Question 3: Which of the following best explains why executive functioning deficits appear early in Alzheimer's disease progression?
- The cerebellum degenerates before the hippocampus
- Prefrontal cortex circuits are disrupted by early amyloid pathology (Correct answer)
- Motor cortex neurons are the first to lose myelin
- Limbic system damage preferentially targets executive networks
Correct answer: Prefrontal cortex circuits are disrupted by early amyloid pathology
Early amyloid accumulation in prefrontal and associated circuits disrupts executive networks before global cognitive decline becomes apparent.
Question 4: During the MoCA abstraction task, a patient is asked how a train and a bicycle are alike. The answer 'they both have wheels' receives what score?
- 1 point — correct abstract similarity
- 0 points — too concrete or superficial (Correct answer)
- 1 point — partial credit
- 0 points — unrelated response
Correct answer: 0 points — too concrete or superficial
Responses citing a concrete physical feature (wheels) rather than an abstract category (means of transportation/vehicles) receive 0 points on the MoCA abstraction task.
Question 5: A clinician notices a patient can recall stored information but struggles to initiate problem-solving strategies spontaneously. This pattern most suggests impairment in which executive subdomain?
- Working memory storage
- Inhibitory control
- Initiation and generativity (Correct answer)
- Sustained attention
Correct answer: Initiation and generativity
Difficulty spontaneously initiating strategies while retrieval remains intact points to impaired initiation and generativity, a key executive subdomain.
Question 6: Which MoCA domain score would be most directly affected if a patient cannot hold a sequence of numbers in mind while performing a mental operation?
- Language domain
- Memory domain
- Attention/executive domain (Correct answer)
- Visuospatial domain
Correct answer: Attention/executive domain
Holding and manipulating information in mind simultaneously is working memory, assessed within the MoCA's attention and executive functioning domain.
Question 7: 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?
- Semantic memory
- Response inhibition and sustained attention (Correct answer)
- Prospective memory
- Lexical retrieval
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.
MoCA Executive Functioning 2
On the MoCA Trail Making B task, a patient connects numbers and letters in this order: 1-A-2-B-3-C.
What cognitive ability does this primarily test?