July 30, 2024 – With the term “cognitive test” now part of everyday conversation, brain health experts are welcoming the chance to explain exactly what these tests can and can’t do.
While there are different types of cognitive tests, “what we are talking about [often] are mostly cognitive screening tests,” said Joe Verghese, a cognitive neurologist and a division chief at Montefiore Medical Center in the Bronx, NY. He holds the English equivalent of a medical degree.
While people may think the tests are the answer to whether they have dementia, Verghese said they are not by themselves diagnostic. “They’re designed to decide if someone has a higher riskof mild cognitive impairment,” he said.
With mild cognitive impairment, an older adult has more thinking or memory problems than peers. Those with the disorder have a higher risk, but not a certainty, of getting dementia.
Among the most common of the basic cognitive screening tests:
- Montreal Cognitive Assessment: During this test, you memorize a short word list, name objects shown in pictures, copy shapes, and do other tasks. Time: 15 minutes.
- Mini-Mental State Exam (MMSE): Count backward, identify objects in a room, say the date, and say other information that’s well-known. Time: 10 minutes.
- Mini-Cog: Memorize and then recall a three-word list of unrelated words and draw a circle clock (adding time points and drawing hands to depict a specific time). Time: 3 minutes.
Since these basic screening tests are so quick and simple, should older adults get one? In a 2020 recommendation, the U.S. Preventive Services Task Force said evidence is lacking to measure the balance of benefits and harms of widespread screening for cognitive impairment in older adults, ages 65 and above, and more research is needed. The task force is an independent volunteer panel of experts that makes evidence-based recommendations on clinical preventive services such as testing.
After the Screener, What’s Next?
If you fail one of the cognitive screening tests, it doesn’t mean you have dementia, but it does show that further testing is warranted, Verghese said.And if you ace it? “If you pass, it doesn’t mean you’re completely normal, just less likely to have dementia.”
If the quick screeners show reason for concern, health care providers will move on to more comprehensive diagnostic tests, which can take 1 to 3 hours, Verghese said, and probe more into brain functioning.
“It’s not practical to screen everyone with a 3-hour test,” Verghese said. They’re meant for older patients who come in with cognitive concerns, or when the family of older patients express concerns. The 65 cut-off is arbitrary, Verghese said. A 65-year-old, of course, could be cognitively and physically healthy, while a 55-year-old could be frail.
It’s important to distinguish between the two types of tests, said Shehroo Pudumjee, PhD, a neuropsychologist at the Cleveland Clinic’s Lou Ruvo Center for Brain Health in Las Vegas. The simple tests “are very quick, but are screeners, not full comprehensive tests,” she said. They are designed to pick up on cognitive impairments, but not designed to be very specific.
The comprehensive evaluation is very patient-based, she said, so it’s impossible to give a list of exactly what’s included. It should start with a comprehensive history, including questions about medications (such as antihistamines for colds or sleep) or conditions (multiple sclerosis, depression, concussions) that might affect mental functioning.
Health care providers would also ask family and other loved ones what they are noticing in terms of cognitive concerns, how the person is sleeping, and other details. Next, Pudumjee said, cognitive tests would evaluate more intensely a person’s thinking, memory, and other brain functions.The word list would be more challenging, for instance, than in the screener.
The results might point to a major cognitive disorder, such as Alzheimer’s or other dementia, or might suggest another disease, such as Parkinson’s or multiple sclerosis, Pudumjee said.
Who Aces the Tests?
In a recent study from the United Kingdom, researchers evaluated nearly 27,000 people, ages 53 to 86, and found that night owls did better on cognitive function tests than did morning “larks.” They also found a link between normal sleep duration of 7 to 9 hours and better cognitive scores.
Simply getting enough sleep to perform well on the tests might be most important, Verghese said. He noted that some older people may have sleep issues, and lack of sleep is a risk factor for dementia.
New Options
To help primary care providers detect cognitive problems in their patients, Verghese and his colleagues recently developed a test called the 5-Cog paradigm, an easy, 5-minute assessment that is paired with recommendations built into the electronic medical records system to improve diagnosis and treatment.
In the research, Verghese and his colleagues evaluated 1,201 primary care patients, with a median age of nearly 73, with cognitive concerns, assigned to get the new test or to be in a control group that didn’t get it.
Over the next 90 days, those who took the test were three times more likely than those who didn’t to have benefitted from improved dementia care actions, such as being diagnosed for mild cognitive impairment or dementia, being referred to specialists, or receiving medications that could help.
The test includes a picture-based memory-impairment screening test, a brief picture-based symbol match, and confirmation that the patient has cognitive complaints.
Primary care providers are often the first to see patients developing cognitive problems, Verghese said, but they are often focused on tending to patients’ other multiple health concerns, so the quick test is valuable.
If providers are not charging patients for it, it’s accessible from Montefiore, he said.
Vocal Clues to Cognitive Fitness
Vocal biomarkers – such as speech rate and pause duration – are becoming potentially valuable to detect cognitive impairment, according to research presented Monday at the Alzheimer’s Association International Conference in Philadelphia. Researchers from Montefiore Medical Centerand Sonde Health, a voice-based health tracking company, reported on the results of cognitive screening and vocal analysis in more than 200 people, finding the vocal analysis aligned with the traditional assessments.
Because voice-enabled devices are so common, automated vocal analysis could become useful to detect cognitive impairment early and monitor it, the researchers said. Sonde Health already offers companies mental and respiratory fitness trackers; it has expanded options with its Sonde Cognitive Fitness, which examines eight vocal traits from 30-second voice interactions and creates a score to provide feedback on one’s cognitive state.
Do-It-Yourself Cognitive Test?
Numerous do-it-yourself cognitive tests are available online. One, called SAGE, for Self-Administered Gerocognitive Exam, was developed at Ohio State University. Users are encouraged to download it, complete it, and then take it to their health care provider for analysis.
The exam usually takes about 15 minutes and asks users to answer basic medical history questions, do basic math, identify everyday objects, copy a simple drawing, and draw a clock and fill it in.
The evaluation by a health care provider is crucial, Verghese said. “A test without follow-up is not advisable,” he said.
Addressing Concerns
Don’t ignore concerns about cognitive health, Verghese said. “If you have a cognitive concern or notice cognitive concerns in a loved one, go and get a screening test,” he said. “In most cases, it may turn out to be normal aging, in which case [the result] is reassuring.”
And if a cognitive issue is found? “Catching it early is very important,” he said. There might be treatment or preventive strategies to help.
