MoCA Orientation and Attention 2 — Questions and Answers
Question 1: What is the maximum number of points available in the attention section of the MoCA?
- 3
- 5
- 6 (Correct answer)
- 8
Correct answer: 6
Attention is worth up to six points across three tasks.
The MoCA attention section includes forward digit span (1 point), backward digit span (1 point), the letter A vigilance task (1 point), and serial 7 subtraction (up to 3 points). Together these give a maximum of six points, making attention one of the larger contributors to the 30-point total.
Question 2: How many digits are in the forward span sequence and how many in the backward span sequence on the MoCA?
- Three forward, three backward
- Five forward, three backward (Correct answer)
- Five forward, five backward
- Seven forward, four backward
Correct answer: Five forward, three backward
Forward span uses five digits; backward span uses three.
On the standard MoCA, the examiner reads a five-digit sequence for the patient to repeat in the same order, then a three-digit sequence to repeat in reverse order. Each sequence is worth one point and each is presented only once. The sequences are read at one digit per second.
Question 3: Which section of the MoCA is administered last?
- Attention
- Delayed recall
- Orientation (Correct answer)
- Abstraction
Correct answer: Orientation
Orientation is the final section, after delayed recall.
The MoCA follows a fixed order: visuospatial/executive, naming, memory registration, attention, language, abstraction, delayed recall, and finally orientation. Keeping this order matters because the delay before word recall depends on the intervening tasks.
Question 4: A patient gets the day of the week wrong but correctly answers the date, month, year, place, and city. What is the orientation score?
- 6
- 5 (Correct answer)
- 4
- 0
Correct answer: 5
Each item is scored independently, so one miss gives 5 out of 6.
The six orientation items are independent. The patient loses only the point for the day of the week and keeps the other five. Clinically, missing the day of the week alone is common in hospitalized patients and does not carry the same weight as missing the year or the city.
Question 5: Why is the orientation section of the MoCA considered clinically significant even though it is easy?
- Because it is weighted double in the total score
- Because errors on easy items often indicate more advanced impairment or delirium (Correct answer)
- Because it is the only section used for the education adjustment
- Because it determines whether the rest of the test is administered
Correct answer: Because errors on easy items often indicate more advanced impairment or delirium
Orientation is usually preserved early, so errors suggest more significant impairment.
Orientation to time and place is typically intact in mild cognitive impairment and early dementia. When a patient loses orientation points, particularly for the year, the place, or the city, it usually indicates more advanced cognitive decline or an acute confusional state such as delirium. Examiners should interpret orientation errors alongside the rest of the profile.
Question 6: In the MoCA serial 7 subtraction task, a patient answers 93, 85, 78, 71, 64. How many points are awarded?
- 0
- 1
- 2
- 3 (Correct answer)
Correct answer: 3
Four of the five subtractions are correct, which earns the full 3 points.
The MoCA scores serial 7s by checking each subtraction independently against the patient's own prior answer. Here 93 is correct, 85 is wrong (93 - 7 = 86), but 78, 71, and 64 are each correctly 7 less than the previous response. Four correct subtractions gives 3 points; two or three correct gives 2 points; one correct gives 1 point; none gives 0.
MoCA Orientation and Attention 2
What is the maximum number of points available in the attention section of the MoCA?