MoCA Executive Functioning 2 — Questions and Answers
Question 1: Which MoCA task specifically assesses the ability to shift between mental sets (cognitive flexibility)?
- Letter fluency
- Trail Making B alternation task (Correct answer)
- Digit span backward
- Clock drawing contour
Correct answer: Trail Making B alternation task
The Trail Making B task (connecting numbers and letters alternately: 1-A-2-B-3-C...) is the executive flexibility task in the MoCA. It tests the ability to alternate between two sets of stimuli.
Question 2: On the MoCA Trail Making B task, the patient must connect numbers and letters in which order?
- All numbers first, then all letters
- 1-A-2-B-3-C-4-D-5-E in alternating order (Correct answer)
- Letters first then numbers
- Random order of numbers and letters
Correct answer: 1-A-2-B-3-C-4-D-5-E in alternating order
The patient must draw a line alternating between numbers and letters in ascending order: 1 → A → 2 → B → 3 → C → 4 → D → 5 → E, alternating correctly throughout.
Question 3: How is the MoCA Trail Making B task scored?
- 1 point for each correct connection
- 0 or 1 point total — 1 for error-free completion (Correct answer)
- 3 points for full sequence, 1 for partial
- 0.5 per correct connection up to 5
Correct answer: 0 or 1 point total — 1 for error-free completion
The MoCA Trail Making B is scored as 1 point (correct) or 0 points (incorrect). The patient earns 1 point only if the entire sequence is completed without any sequencing errors.
Question 4: The letter fluency task in the MoCA requires the patient to generate as many words as possible beginning with which letter?
- S
- A
- F (Correct answer)
- T
Correct answer: F
The standard MoCA letter fluency (phonemic fluency) task uses the letter F. The patient has 60 seconds to name as many words starting with F as possible, with a cutoff of 11 or more words for 1 point.
Question 5: How many words beginning with F must a patient generate in 60 seconds to earn the MoCA letter fluency point?
- 5 or more
- 8 or more
- 11 or more (Correct answer)
- 15 or more
Correct answer: 11 or more
The patient must produce 11 or more F-words in 60 seconds to earn 1 point. Proper nouns and the same word said again (with different endings) do not count.
Question 6: Clock drawing is included in the MoCA Visuospatial/Executive domain because it requires:
- Memory for clock designs seen before
- Only fine motor skills
- Executive planning and spatial construction together (Correct answer)
- Verbal reasoning about time
Correct answer: Executive planning and spatial construction together
Beyond spatial construction, clock drawing requires the patient to plan and execute a sequence of steps (draw circle, place numbers, set hands to a time), engaging the executive planning system.
MoCA Executive Functioning 2
Which MoCA task specifically assesses the ability to shift between mental sets (cognitive flexibility)?