MoCA Attention and Concentration 3 — Questions and Answers
Question 1: At what rate should the examiner read the letters aloud during the MoCA vigilance task?
- One per 2 seconds
- One per second (Correct answer)
- Two per second
- As fast as comfortable
Correct answer: One per second
The standard rate for reading the letter sequence in the vigilance task is one letter per second. This controlled pace is essential for standardized administration.
Question 2: A patient correctly subtracts 7 from 100 three times but then gives an incorrect fourth answer. How many points are awarded for serial 7s?
- 2 points
- 3 points (Correct answer)
- 4 points
- 1 point
Correct answer: 3 points
Three consecutive correct subtractions earns 3 points. The scoring stops counting correct subtractions after the run ends; only the number of correct responses (up to 5 attempts) is counted.
Question 3: On the backward digit span task, the examiner reads the digits at one per second and asks the patient to repeat them:
- In the same order heard
- In reverse order (Correct answer)
- Alphabetically
- Skipping every other digit
Correct answer: In reverse order
The backward digit span instruction asks the patient to repeat the sequence in reverse order. This taxes working memory more than the forward span.
Question 4: Why does the MoCA include both forward AND backward digit span tasks?
- To fill time during the test
- Because one is always harder than the other
- Forward span tests attention; backward span adds working memory demands (Correct answer)
- Both tasks test the same cognitive function identically
Correct answer: Forward span tests attention; backward span adds working memory demands
Forward span primarily tests auditory attention, while backward span additionally requires mental manipulation (working memory). Together they provide a more complete picture of attentional capacity.
Question 5: Which patient behavior during the serial 7s task should the examiner accept as correct?
- Only if all 5 answers are perfect
- Each subtraction is scored independently from the preceding answer given (Correct answer)
- Only if the patient reaches 65
- Only if the patient can explain the process
Correct answer: Each subtraction is scored independently from the preceding answer given
Each subtraction is evaluated independently. If a patient says 93, then 87, the second answer of 87 is accepted because 93 - 7 = 86 — wait, evaluating sequentially: 93 is correct (100-7), then 86 (93-7) is correct. Answers are scored on each individual subtraction from the prior response.
Question 6: In the context of the MoCA, concentration refers to the ability to:
- Remember words over a long delay
- Perform sustained sequential mental operations without distraction (Correct answer)
- Name objects presented visually
- Follow a multi-step command
Correct answer: Perform sustained sequential mental operations without distraction
Concentration as measured by the MoCA serial 7 task requires sustained mental effort to perform sequential arithmetic, reflecting the ability to hold information and manipulate it without distraction.
MoCA Attention and Concentration 3
At what rate should the examiner read the letters aloud during the MoCA vigilance task?