What cognitive tests can tell you about a person’s brain health

What cognitive tests can tell you about a person’s brain health
What cognitive tests can tell you about a person’s brain health

Political opponents, amateur commentators and even nervous supporters are demanding that President Joe Biden undergo such tests after his disastrous debate performance – even though his doctor says he undergoes and passes an annual neurological exam.

Former President Donald Trump, who is only a few years younger, also makes his own faux pas. For example, he recently boasted about passing a cognitive test in 2018 – but gave the doctor who administered it the wrong name.

All this concern raises the question of what cognitive tests can actually tell us about a person’s brain health—and what can’t they answer? And presidents aside, does the average older adult even need such a test?

What are cognitive tests?

These are short screening tools, a 10-minute series of questions designed to assess various brain functions. Two of the most common are MMSE (Mini-Mental State Exam) and MoCA (Montreal Cognitive Assessment).

Remembering a list of five unrelated nouns or seeing how many words starting with F you can say in a minute can test your short-term memory and language. Counting backwards by 7 tests attention and concentration. Drawing a clock with the correct time on it is a test of spatial awareness.

How reliable are cognitive screenings?

They do not diagnose health problems. A bad reading is just a warning sign that requires further testing to determine if there is a health problem, and if so, what kind, says Dr. James Galvin, a neurologist at the University of Miami.

A good result is usually good news. But highly educated people tend to be good test takers, even when cognitive problems are developing. So if someone gets a normal result but they, a family member, or their doctor notices problems in their daily life, further testing may still be appropriate.

“We simply use it as a benchmark to determine our level of distrust,” Galvin said.

When and how often should cognitive screenings be performed?

“A screening test is a snapshot in time. So it tells you in that moment how someone performs on the test,” Galvin stressed. “It doesn’t tell you how a person copes in everyday life.”

Simply reporting a problem is reason enough for a primary care doctor to conduct such an examination. For people ages 65 and older, the examination is also part of the annual Medicare health examination.

Galvin didn’t want to talk about Biden or Trump because he hasn’t studied them – but said it’s generally a good idea for seniors to get annual checkups to check for changes. It’s similar to doctors not assuming your blood pressure is OK but taking it.

How does a cognitive test differ from a neurological examination?

Cognitive screenings are “pencil and paper tests” typically performed by general practitioners, while neurological exams are generally done by a specialist, Galvin said.

It is a very detailed physical exam. Doctors observe the patient’s speech patterns and behavior, test the function of important nerves, check reflexes that may indicate brain disorders, and assess muscle tone and function.

If any of the tests indicate actual cognitive problems, the next step may be a more intensive neuropsychological assessment, which often takes up to three hours.

After a thorough interview with the patient and any accompanying family members, the neuropsychologist administers tests and tasks designed to assess specific brain functions – intelligence, memory, language skills, problem-solving and reasoning skills, visual and auditory responses, emotions and mood. Puzzles, objects to rearrange, or drawing and writing tests may be used.

Blood tests and brain scans may also be ordered. Special types of PET scans can detect the amyloid plaques and tau fibrils in the brain that are typical of Alzheimer’s. An MRI can detect previous strokes, which helps diagnose vascular dementia.

How can you tell if cognitive problems are a disease or simply a part of getting older?

“As we get older, we do things a lot slower,” Galvin said. “We move slower. We think slower. But we still move right and we still think right – it just takes us longer.”

Examples of slower cognitive “processing” might include difficulty remembering a name, numbers, or specific details under pressure – but they come back to you later.

Galvin noted that reversible health problems sometimes resemble cognitive disorders. Urinary tract infections, for example, are known to cause sudden confusion in the elderly. Certain medications impair memory, as do thyroid problems, depression and even poorly controlled diabetes.

Anyone concerned about their memory should talk to their doctor or see a specialist “who can reassure you that everything is OK or develop a treatment plan specifically tailored to you,” he said.

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