MoCA Executive Functioning 3 — Questions and Answers
Question 1: A 72-year-old patient performs well on simple attention tasks but fails when two tasks must be performed simultaneously. This difficulty is best described as impaired:
- Selective attention
- Divided attention (Correct answer)
- Alerting attention
- Sustained attention
Correct answer: Divided attention
Difficulty managing two simultaneous tasks reflects impaired divided attention, which is a component of executive functioning assessed on complex cognitive tests.
Question 2: On MoCA serial subtraction (100 minus 7, repeated), a patient makes one error but continues correctly from the wrong number. How many points is typically awarded?
- 0 points
- 2 points
- 3 points (Correct answer)
- 4 points
Correct answer: 3 points
The MoCA awards 3 points for 4–5 correct subtractions, 2 points for 2–3 correct, 1 point for 1 correct, and 0 for none; one error with correct continuation typically yields 3 points if enough subsequent answers are correct.
Question 3: A neuropsychologist describes a patient as having 'poor cognitive flexibility.' On the MoCA, this most directly impairs performance on which task?
- Cube copy
- Delayed recall
- Trail Making alternating sequence (Correct answer)
- Clock drawing hands only
Correct answer: Trail Making alternating sequence
The alternating Trail Making B task (1-A-2-B…) directly measures cognitive flexibility, the ability to shift mental set between two categories.
Question 4: Which statement correctly describes the relationship between executive functioning and the frontal lobes?
- Executive functions are exclusively controlled by the temporal lobe
- The frontal lobes, especially the prefrontal cortex, are the primary substrate for executive functions (Correct answer)
- Executive functions are equally distributed across all four lobes
- The parietal lobe is the primary executive hub
Correct answer: The frontal lobes, especially the prefrontal cortex, are the primary substrate for executive functions
The prefrontal cortex is the primary neural substrate for executive functions including planning, inhibition, working memory, and cognitive flexibility.
Question 5: A patient with intact language but impaired executive functioning is asked to name all animals they can think of in 60 seconds. What specific deficit would most reduce their score?
- Reduced vocabulary
- Impaired strategic search and self-monitoring of already-named items (Correct answer)
- Poor phonological processing
- Reduced semantic memory storage
Correct answer: Impaired strategic search and self-monitoring of already-named items
Executive dysfunction impairs the strategic organization of semantic search and monitoring for perseverations, reducing category fluency output even when semantic knowledge is preserved.
Question 6: On the MoCA, the abstraction subtest is scored out of how many points?
- 1 point total
- 2 points total (Correct answer)
- 3 points total
- 4 points total
Correct answer: 2 points total
The MoCA abstraction subtest consists of two similarity pairs, each worth 1 point, for a maximum total of 2 points.
Question 7: A patient can understand instructions but repeatedly returns to a previously correct response when the rule changes mid-task. This pattern is most consistent with:
- Anterograde amnesia
- Perseveration due to executive dysfunction (Correct answer)
- Receptive aphasia
- Confabulation
Correct answer: Perseveration due to executive dysfunction
Perseveration — the inability to abandon a previously correct response when rules change — is a hallmark of executive dysfunction, often associated with frontal lobe damage.
MoCA Executive Functioning 3
A 72-year-old patient performs well on simple attention tasks but fails when two tasks must be performed simultaneously.
This difficulty is best described as impaired: