MoCA Trail Making (Alternating Trail Making) — Questions and Answers
Question 1: In the MoCA Trail Making task, what is the correct sequence the examinee must draw?
- Numbers only in ascending order (1-2-3-4-5)
- Letters only in alphabetical order (A-B-C-D-E)
- Alternating numbers and letters (1-A-2-B-3-C-4-D-5-E) (Correct answer)
- Numbers and letters matched by value (1-A, 2-B, etc.) drawn as pairs
Correct answer: Alternating numbers and letters (1-A-2-B-3-C-4-D-5-E)
The MoCA trail making task requires drawing a line that alternates between numbers and letters in ascending/alphabetical order: 1-A-2-B-3-C-4-D-5-E. It is an abbreviated version of the Trail Making Test Part B and specifically tests cognitive flexibility (set-shifting).
Question 2: How many points is the Trail Making task worth on the MoCA?
- 1 point (Correct answer)
- 2 points
- 3 points
- 5 points
Correct answer: 1 point
The Trail Making task is worth exactly 1 point, awarded only when the examinee completes the full alternating sequence (1-A-2-B-3-C-4-D-5-E) without any uncorrected errors.
Question 3: Under which MoCA domain is the Trail Making task classified?
- Memory
- Language
- Attention
- Visuospatial/Executive (Correct answer)
Correct answer: Visuospatial/Executive
The Trail Making task falls under the Visuospatial/Executive domain alongside cube copying and clock drawing. It measures executive function through set-shifting and the ability to alternate between two sequences.
Question 4: What should an examiner do if the examinee makes an error during the MoCA Trail Making task?
- Stop the test immediately and record a score of 0
- Say nothing and let the examinee continue to the end
- Point out the error immediately and ask the examinee to continue from the last correct connection (Correct answer)
- Allow the examinee to start the entire task over from the beginning
Correct answer: Point out the error immediately and ask the examinee to continue from the last correct connection
Per standardized MoCA administration, when an error occurs the examiner immediately points to it and instructs the examinee to continue from the last correct connection. This preserves standardization while allowing task completion; errors are factored into scoring.
Question 5: What cognitive ability does the MoCA Trail Making task primarily assess?
- Immediate verbal memory span
- Set-shifting and cognitive flexibility (Correct answer)
- Three-dimensional visuoconstructional ability
- Sustained vigilance over time
Correct answer: Set-shifting and cognitive flexibility
The alternating Trail Making task is a measure of set-shifting — the ability to switch mental sets between numbers and letters — which is a core executive function. Impairment is seen early in MCI and frontal lobe dysfunction.
Question 6: Which of the following is a reason the MoCA uses an abbreviated Trail Making task rather than the full Trail Making Test Part B?
- The full TMT Part B is protected by copyright and cannot be used
- The abbreviated version reduces administration burden while still capturing executive set-shifting ability (Correct answer)
- The full TMT Part B measures a different cognitive domain
- The MoCA version is scored on a 5-point scale, unlike the timed TMT
Correct answer: The abbreviated version reduces administration burden while still capturing executive set-shifting ability
The MoCA is designed as a brief cognitive screening tool (~10 minutes total). The abbreviated Trail Making sequence (ending at 5-E rather than continuing further) captures the essential set-shifting measure while minimizing testing time, consistent with the MoCA's screening purpose.
MoCA Trail Making (Alternating Trail Making)
In the MoCA Trail Making task, what is the correct sequence the examinee must draw?