MoCA - Montreal Cognitive Assessment — Questions and Answers

Question 1: How should a trained MoCA examiner respond if a patient volunteers one of the five target words during an intervening subtest?

Acknowledge it neutrally but do not reward it as a Delayed Recall response (Correct answer)
Tell the patient to wait and repeat the word back to reinforce memory
Immediately administer the Delayed Recall subtest
Credit the word as recalled and move on

Correct answer: Acknowledge it neutrally but do not reward it as a Delayed Recall response

The examiner should neither discourage nor specifically reward spontaneous mentions during other subtests; only responses given during the formal Delayed Recall prompt count toward the score.

Question 2: A patient with right hemisphere damage attempts clock drawing. Which pattern of errors is most anticipated?

Numbers crowded onto the left side with right side of clock empty (Correct answer)
Perseveration causing the same number to be written multiple times
Stimulus-pull error with hands pointing to '10' and '11'
Numbers crowded onto the right side with left side of clock empty

Correct answer: Numbers crowded onto the left side with right side of clock empty

Right hemisphere damage causes left hemispatial neglect, leading patients to omit or compress numbers on the left (contralateral) side of the clock.

Question 3: How does the MoCA Orientation section differ from the MMSE Orientation section?

The MoCA asks more orientation questions than the MMSE
The MoCA does not include an orientation section
Both tests ask identical orientation questions
The MoCA asks fewer orientation questions than the MMSE (Correct answer)

Correct answer: The MoCA asks fewer orientation questions than the MMSE

The MMSE Orientation section has 10 items (5 time, 5 place), while the MoCA has only 6 orientation items.

Question 4: An examiner is about to administer the MoCA to a patient who is blind. How should the Orientation section be adapted?

Read the orientation questions from a Braille card only
Replace place and city items with tactile location tasks
No adaptation is needed; orientation questions are entirely verbal (Correct answer)
Skip the orientation section entirely for blind patients

Correct answer: No adaptation is needed; orientation questions are entirely verbal

The MoCA Orientation questions are purely verbal and require no visual stimuli, so no modification is needed for blind patients.

Question 5: A patient with right hemisphere parietal damage would MOST likely show difficulties on which MoCA visuospatial tasks?

Naming and abstract thinking only
Cube copy and clock drawing, possibly with left-sided neglect features (Correct answer)
Sentence repetition and letter fluency only
Serial 7 subtraction and digit span only

Correct answer: Cube copy and clock drawing, possibly with left-sided neglect features

Right parietal lesions typically produce left-sided spatial neglect and visuoconstructional deficits. This would affect the cube copy and clock drawing (particularly left-sided neglect: numbers clustered on the right, left hand incorrect).

Question 6: Which condition, other than Alzheimer's disease, is well known for causing poor MoCA delayed recall scores?

Peripheral neuropathy
Vascular cognitive impairment (Correct answer)
Mild depression only
Essential tremor

Correct answer: Vascular cognitive impairment

Vascular cognitive impairment (VCI) commonly produces memory and executive deficits that are detected by the MoCA.

Question 7: Why does the MoCA include both forward AND backward digit span tasks?

Forward span tests attention; backward span adds working memory demands (Correct answer)
Because one is always harder than the other
Both tasks test the same cognitive function identically
To fill time during the test

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 8: On MoCA sentence repetition, a patient adds the word 'little' before 'cat' in the first sentence. How is this scored?

No point; additions count as errors (Correct answer)
Half point for partial accuracy
Full point if the rest is verbatim
Examiner may accept it as equivalent

Correct answer: No point; additions count as errors

Any addition to the sentence, even a small modifier, violates verbatim repetition requirements and results in no point for that sentence.

Question 9: Why is Clock Drawing important for assessing cognitive disorders?

It is irrelevant to diagnosing cognitive disorders.
It is only useful for diagnosing motor disorders.
It only applies to physical health issues.
It helps in detecting cognitive disorders by evaluating clock drawing. (Correct answer)

Correct answer: It helps in detecting cognitive disorders by evaluating clock drawing.

This question assesses the importance of the subject in identifying cognitive disorders.

Question 10: During the MoCA abstraction task, a patient is asked how a train and a bicycle are alike. The answer 'they both have wheels' receives what score?

1 point — correct abstract similarity
1 point — partial credit
0 points — too concrete or superficial (Correct answer)
0 points — unrelated response

Correct answer: 0 points — too concrete or superficial

Responses citing a concrete physical feature (wheels) rather than an abstract category (means of transportation/vehicles) receive 0 points on the MoCA abstraction task.

Question 11: Which patient is MOST likely to fail the year orientation item on the MoCA?

A 65-year-old with well-controlled type 2 diabetes
A 70-year-old with mild depression
An 80-year-old with moderate Alzheimer's disease requiring full care (Correct answer)
A 75-year-old with mild cognitive impairment

Correct answer: An 80-year-old with moderate Alzheimer's disease requiring full care

Year disorientation typically occurs in moderate-to-severe dementia. A patient with moderate Alzheimer's disease who requires full care is the most likely to be disoriented to year.

Question 12: Which condition would most directly impair a patient's ability to complete the MoCA serial 7s task?

Peripheral neuropathy
Working memory impairment (Correct answer)
Visual field defect
Hearing loss only

Correct answer: Working memory impairment

Working memory is essential for holding intermediate results during sequential subtraction.

Question 13: Early Alzheimer's disease most characteristically impairs which aspect of the MoCA memory task?

Semantic category knowledge
Encoding speed during learning trials
Spontaneous delayed free recall (Correct answer)
Ability to recognize words from a list

Correct answer: Spontaneous delayed free recall

Hippocampal damage in early AD characteristically causes poor spontaneous delayed free recall before recognition is affected.

Question 14: Which two categories of orientation does the MoCA specifically test?

Personal and situational orientation
Temporal and spatial orientation (Correct answer)
Spatial and social orientation
Temporal and personal orientation

Correct answer: Temporal and spatial orientation

The MoCA tests temporal orientation (date, month, year, day of week) and spatial orientation (where we are and the city). Both are clinically important in detecting dementia.

Question 15: Why does the MoCA assess visuospatial abilities rather than limiting testing to verbal and memory tasks?

Because visuospatial tasks are easy to score objectively
Because visuospatial deficits are prominent in several dementia subtypes (Correct answer)
Because the MoCA is designed for visual artists
Because verbal and memory tasks are sufficient alone

Correct answer: Because visuospatial deficits are prominent in several dementia subtypes

Visuospatial deficits are prominent features of Alzheimer's disease, Lewy body dementia, and posterior cortical atrophy. Including visuospatial tasks increases the sensitivity of the MoCA for detecting these specific dementia subtypes.

Question 16: What cognitive processes are simultaneously engaged during serial 7 subtraction?

Only arithmetic recall
Visuospatial processing and naming
Only working memory
Arithmetic, working memory, sustained attention, and mental flexibility (Correct answer)

Correct answer: Arithmetic, working memory, sustained attention, and mental flexibility

Performing serial 7s requires arithmetic knowledge, working memory to hold the running total, sustained attention to stay on task, and mental flexibility — making it a rich multi-domain task.

Question 17: Why is Clock Drawing important in cognitive health?

It is important for maintaining clock drawing and overall cognitive processing. (Correct answer)
It only applies to physical health.
It has little to no effect on mental health.
It is not necessary for daily living.

Correct answer: It is important for maintaining clock drawing and overall cognitive processing.

This question explores the significance of the subject in maintaining cognitive health.

Question 18: A clinician skips the sentence repetition task to save time. What is the effect on the MoCA total score?

The score loses up to 2 possible points (Correct answer)
The score loses up to 3 possible points
The score must be prorated
No effect; it is optional

Correct answer: The score loses up to 2 possible points

Skipping sentence repetition removes 2 scorable points from the total, affecting validity.

Question 19: Which of the following is an example of a CORRECT abstract response to 'how are a train and bicycle alike?'

Both are modes of transportation (Correct answer)
Both make noise
Both require a driver
Both have wheels

Correct answer: Both are modes of transportation

Identifying the superordinate category 'modes of transportation' is the abstract categorical answer that earns credit.

Question 20: A bilingual patient answers the abstraction pair correctly in Spanish instead of English. How should the examiner score this?

Document as invalid and exclude from scoring
Prompt the patient to answer in English before scoring
Full credit if the response is categorically correct (Correct answer)
0 points — must respond in English

Correct answer: Full credit if the response is categorically correct

MoCA scoring is based on conceptual correctness; a correct categorical response in any language should receive full credit.

Question 21: Which MoCA language subtest asks the patient to produce language spontaneously rather than repeat or recognize?

Orientation
Letter fluency (Correct answer)
Animal naming
Sentence repetition

Correct answer: Letter fluency

Letter fluency requires the patient to self-generate words, making it the only MoCA language task that demands spontaneous verbal production.

Question 22: How many learning trials are given for the word list on the MoCA, and does the examiner stop early if the patient repeats all five words on the first try?

One trial; a second is given only if the patient misses a word
Three trials regardless of performance
Two trials, and the second is given even if the first was perfect (Correct answer)
As many trials as needed until all five words are recalled

Correct answer: Two trials, and the second is given even if the first was perfect

Two learning trials are always administered, regardless of first-trial performance.

Question 23: How many digits are in the forward digit span sequence used in the MoCA?

3 digits
7 digits
4 digits
5 digits (Correct answer)

Correct answer: 5 digits

The MoCA forward digit span uses a 5-digit sequence (e.g., 5-4-2-1-8). The examinee must repeat the digits in exactly the same order presented. This tests auditory registration and immediate attention span.

Question 24: How does the MoCA handle scoring if a patient gives the correct day of the week but is off by one day due to confusion about midnight administration?

No credit is given; the exact correct day must be stated (Correct answer)
The examiner re-administers the question the following morning
A one-day error is always accepted as correct
The examiner prompts the patient with the correct day

Correct answer: No credit is given; the exact correct day must be stated

Standard MoCA scoring requires the exact correct response; partial credit or adjusted scoring is not permitted for the day item.

Question 25: When evaluating calculation ability with the MoCA serial 7 task, clinicians should be cautious interpreting low scores in patients who:

Have limited formal education or low numeracy backgrounds (Correct answer)
Are over 65 years old
Are native English speakers
Have hearing impairments

Correct answer: Have limited formal education or low numeracy backgrounds

Education and cultural background strongly influence performance on arithmetic tasks. Low serial 7 scores in individuals with limited formal education may not reflect cognitive impairment.

Question 26: On the MoCA, the serial 7s task belongs to which section of the assessment?

Language
Orientation
Attention (Correct answer)
Memory

Correct answer: Attention

Serial 7s is part of the Attention domain on the MoCA, along with digit span and vigilance tasks.

Question 27: A researcher compares MoCA abstraction scores in healthy adults aged 65 vs. 85. Which finding is MOST expected?

Abstraction is unaffected by age in healthy adults
The 85-year-old group shows slightly lower scores on average (Correct answer)
The 85-year-old group scores significantly higher
Scores are identical across age groups

Correct answer: The 85-year-old group shows slightly lower scores on average

Normal aging is associated with mild decline in executive functions including abstraction, so older healthy adults tend to score slightly lower.

Question 28: How does poor performance on MoCA letter fluency help differentiate Alzheimer's disease from frontotemporal dementia (FTD)?

FTD typically shows more severe fluency deficits early due to frontal involvement (Correct answer)
Fluency is unaffected in both conditions
FTD affects only semantic fluency, not phonemic fluency
Alzheimer's disease shows greater fluency impairment than FTD

Correct answer: FTD typically shows more severe fluency deficits early due to frontal involvement

FTD predominantly affects frontal-executive systems early, causing disproportionate phonemic fluency deficits compared to Alzheimer's, which initially impacts memory more.

Question 29: How many animal pictures are presented to the patient in the MoCA naming section?

4
3 (Correct answer)
2
5

Correct answer: 3

The MoCA naming section presents exactly 3 animal pictures, one point each, for a maximum score of 3.

Question 30: A bilingual patient claims difficulty with English sentence repetition. What is the recommended approach?

Score the task as 2 points to avoid penalizing language barriers
Replace it with a digit span task
Administer a validated MoCA translation in the patient's stronger language when available (Correct answer)
Skip the task entirely

Correct answer: Administer a validated MoCA translation in the patient's stronger language when available

Using a validated translated version of the MoCA reduces language-barrier bias in non-native English speakers.

MoCA - Montreal Cognitive Assessment

The Montreal Cognitive Assessment screens for mild cognitive impairment across multiple cognitive domains including memory, attention, language, visuospatial abilities, and executive functioning.

Questions

20 min

Time Limit

87%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds