Montreal Cognitive Assessment (MOCA) EXAM with
Questions and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Visuospatial/Executive Function
2. Naming Ability
3. Memory/Delayed Recall
4. Attention and Concentration
5. Language Fluency and Comprehension
6. Abstraction and Conceptualization
7. Orientation to Time and Place
1. A 78-year-old patient with suspected early-stage dementia is asked to draw a clock face set to ten
past eleven. The patient draws the circle correctly, places all numbers correctly, but places both
hands of the clock pointing to the number eleven. Which executive function impairment is
primarily demonstrated?
A. Visuoperceptual deficit
B. Impairment in planning and sequencing
C. Semantic memory loss
D. Agnosia
Answer: B
Rationale: The error in clock face construction indicates a failure in planning and organizing
the spatial representation of time, which is a hallmark of executive dysfunction. Option A is
, incorrect as the patient correctly perceives and places the numbers. Options C and D are
incorrect because the patient demonstrates knowledge of what a clock is and recognizes the
numbers, rather than failing on memory or object recognition.
CORRECT ANSWER : B
2. During the naming task, a patient is shown a picture of a rhinoceros. The patient identifies it as a
"large grey animal with a horn," but cannot produce the specific name "rhinoceros." This error
pattern is most indicative of:
A. Anomic aphasia
B. Category-specific lexical retrieval difficulty
C. Visual agnosia
D. Frontal lobe disinhibition
Answer: B
Rationale: The patient displays semantic knowledge of the object but cannot access the
phonological label, typical of specific lexical retrieval deficits. Option A is less precise than B
for this specific task. Options C and D are incorrect because the patient clearly demonstrates
recognition of the animal's features (visual processing is intact) and is not exhibiting impulsive
or disinhibited behavior.
CORRECT ANSWER : B
3. A patient is asked to repeat a sequence of five digits: 2, 7, 4, 9, 3. The patient repeats them
correctly but fails when asked to repeat them in reverse order (3, 4, 9, 7, 2). This discrepancy
highlights a deficiency in:
A. Long-term memory consolidation
B. Phonological loop capacity
C. Working memory manipulation
D. Auditory processing speed
Answer: C
Rationale: Repeating digits forward tests basic attention/storage, while reversing them tests
working memory's ability to manipulate information. Option B is incorrect because the
phonological loop is utilized in both tasks. Options A and D are incorrect as the task does not
involve long-term storage or generalized auditory processing deficits.
, CORRECT ANSWER : C
4. When assessing verbal fluency, a patient is asked to generate as many words as possible starting
with the letter 'F' in one minute. The patient produces: "Fan, fire, fun, fly, fast, father, family,
football." What does this performance reflect?
A. Perseveration
B. Efficient category-based retrieval
C. Impaired executive set-shifting
D. Fluent agraphia
Answer: B
Rationale: The patient is generating words within a consistent phonemic set efficiently,
suggesting intact frontal lobe retrieval mechanisms. Options A and C are incorrect because
there is no repetition of words or inability to switch to new words within the category. Option D
is incorrect as this is a verbal task, not a writing task.
CORRECT ANSWER : B
5. In the abstraction task, the patient is asked to identify the commonality between a "train" and a
"bicycle." The patient responds, "They both have wheels." Which level of cognitive processing is
demonstrated?
A. Abstract conceptualization
B. Concrete categorization
C. Symbolic reasoning
D. Executive synthesis
Answer: B
Rationale: Identifying a physical attribute (wheels) is a concrete, feature-based response rather
than an abstract one (modes of transportation). Option A is incorrect because an abstract
response would focus on the function of travel. Options C and D are incorrect as the patient is
not operating at the required conceptual level.
CORRECT ANSWER : B
, 6. A patient is asked to perform a serial subtraction of 7 starting from 100. The patient provides the
following sequence: 93, 86, 79, 72, 65. The patient then stops and looks at the examiner. What
aspect of attention is this performance measuring?
A. Sustained attention and mental tracking
B. Short-term auditory memory
C. Semantic processing speed
D. Verbal inhibition
CORRECT ANSWER : A
Rationale: Serial subtraction requires the patient to maintain the task set while performing
mental calculations, assessing sustained attention. Options B and C are incorrect as this is a
mathematical task, not a memory or vocabulary test. Option D is incorrect because the patient
did not demonstrate impulsive or intrusive errors.
7. During the orientation portion, a patient correctly identifies the date, the city, and the building
but fails to identify the floor level. What is the clinical implication of this specific deficit?
A. Global disorientation
B. Impaired environmental awareness
C. Severe memory consolidation deficit
D. Anosognosia
CORRECT ANSWER : B
Rationale: The patient is oriented to time and place at a macro level but lacks awareness of
immediate spatial surroundings, indicating a focal deficit in environmental orientation. Options
A and C are incorrect because the patient is oriented to the larger temporal and geographic
context. Option D is incorrect as there is no evidence of the patient lacking insight into their own
condition.
8. When asked to identify the commonality between a "watch" and a "ruler," the patient states,
"They are both things you measure with." This response is classified as:
A. High-level abstract reasoning
B. Concrete functional association
C. Semantic priming error
Questions and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Visuospatial/Executive Function
2. Naming Ability
3. Memory/Delayed Recall
4. Attention and Concentration
5. Language Fluency and Comprehension
6. Abstraction and Conceptualization
7. Orientation to Time and Place
1. A 78-year-old patient with suspected early-stage dementia is asked to draw a clock face set to ten
past eleven. The patient draws the circle correctly, places all numbers correctly, but places both
hands of the clock pointing to the number eleven. Which executive function impairment is
primarily demonstrated?
A. Visuoperceptual deficit
B. Impairment in planning and sequencing
C. Semantic memory loss
D. Agnosia
Answer: B
Rationale: The error in clock face construction indicates a failure in planning and organizing
the spatial representation of time, which is a hallmark of executive dysfunction. Option A is
, incorrect as the patient correctly perceives and places the numbers. Options C and D are
incorrect because the patient demonstrates knowledge of what a clock is and recognizes the
numbers, rather than failing on memory or object recognition.
CORRECT ANSWER : B
2. During the naming task, a patient is shown a picture of a rhinoceros. The patient identifies it as a
"large grey animal with a horn," but cannot produce the specific name "rhinoceros." This error
pattern is most indicative of:
A. Anomic aphasia
B. Category-specific lexical retrieval difficulty
C. Visual agnosia
D. Frontal lobe disinhibition
Answer: B
Rationale: The patient displays semantic knowledge of the object but cannot access the
phonological label, typical of specific lexical retrieval deficits. Option A is less precise than B
for this specific task. Options C and D are incorrect because the patient clearly demonstrates
recognition of the animal's features (visual processing is intact) and is not exhibiting impulsive
or disinhibited behavior.
CORRECT ANSWER : B
3. A patient is asked to repeat a sequence of five digits: 2, 7, 4, 9, 3. The patient repeats them
correctly but fails when asked to repeat them in reverse order (3, 4, 9, 7, 2). This discrepancy
highlights a deficiency in:
A. Long-term memory consolidation
B. Phonological loop capacity
C. Working memory manipulation
D. Auditory processing speed
Answer: C
Rationale: Repeating digits forward tests basic attention/storage, while reversing them tests
working memory's ability to manipulate information. Option B is incorrect because the
phonological loop is utilized in both tasks. Options A and D are incorrect as the task does not
involve long-term storage or generalized auditory processing deficits.
, CORRECT ANSWER : C
4. When assessing verbal fluency, a patient is asked to generate as many words as possible starting
with the letter 'F' in one minute. The patient produces: "Fan, fire, fun, fly, fast, father, family,
football." What does this performance reflect?
A. Perseveration
B. Efficient category-based retrieval
C. Impaired executive set-shifting
D. Fluent agraphia
Answer: B
Rationale: The patient is generating words within a consistent phonemic set efficiently,
suggesting intact frontal lobe retrieval mechanisms. Options A and C are incorrect because
there is no repetition of words or inability to switch to new words within the category. Option D
is incorrect as this is a verbal task, not a writing task.
CORRECT ANSWER : B
5. In the abstraction task, the patient is asked to identify the commonality between a "train" and a
"bicycle." The patient responds, "They both have wheels." Which level of cognitive processing is
demonstrated?
A. Abstract conceptualization
B. Concrete categorization
C. Symbolic reasoning
D. Executive synthesis
Answer: B
Rationale: Identifying a physical attribute (wheels) is a concrete, feature-based response rather
than an abstract one (modes of transportation). Option A is incorrect because an abstract
response would focus on the function of travel. Options C and D are incorrect as the patient is
not operating at the required conceptual level.
CORRECT ANSWER : B
, 6. A patient is asked to perform a serial subtraction of 7 starting from 100. The patient provides the
following sequence: 93, 86, 79, 72, 65. The patient then stops and looks at the examiner. What
aspect of attention is this performance measuring?
A. Sustained attention and mental tracking
B. Short-term auditory memory
C. Semantic processing speed
D. Verbal inhibition
CORRECT ANSWER : A
Rationale: Serial subtraction requires the patient to maintain the task set while performing
mental calculations, assessing sustained attention. Options B and C are incorrect as this is a
mathematical task, not a memory or vocabulary test. Option D is incorrect because the patient
did not demonstrate impulsive or intrusive errors.
7. During the orientation portion, a patient correctly identifies the date, the city, and the building
but fails to identify the floor level. What is the clinical implication of this specific deficit?
A. Global disorientation
B. Impaired environmental awareness
C. Severe memory consolidation deficit
D. Anosognosia
CORRECT ANSWER : B
Rationale: The patient is oriented to time and place at a macro level but lacks awareness of
immediate spatial surroundings, indicating a focal deficit in environmental orientation. Options
A and C are incorrect because the patient is oriented to the larger temporal and geographic
context. Option D is incorrect as there is no evidence of the patient lacking insight into their own
condition.
8. When asked to identify the commonality between a "watch" and a "ruler," the patient states,
"They are both things you measure with." This response is classified as:
A. High-level abstract reasoning
B. Concrete functional association
C. Semantic priming error
