While we don’t need to mention names, you probably have heard that the concept of “taking a cognitive test” has been in the headlines in recent months. But what exactly is such a test? How do you know whether you should take it? And what will such a test tell you about your cognition or risk of cognitive decline? It’s easy to get caught up in the hoopla surrounding public calls that our older politicians take such tests. But, in reality, is there ever a place for such a test in your own life or the life of an older loved one? For a good overview of cognitive testing, sharpen your pencil and click here.

You should know that the Medicare system anticipates that a simple cognitive test will be a part of the annual Wellness visit and that Medicare also covers a separate visit with your primary care physician to go into more depth about your cognitive functioning. While it appears that most people don’t get such a test on any regular basis, the question is, should you? Although one cognitive test at one time is just a static snapshot of your cognitive functioning, some argue that everyone should get one to establish a “baseline” so that if changes appear, they can be compared to your original test.  According to the American Academy of Neurology, doctors should assess their patients who are older than 65 to get that baseline. As you get beyond that age, the chances of cognitive impairment rise, so that by age 75, 25% of individuals are thought to have some kind of cognitive disorder, sometimes without even being aware of it. AARP recommends that, just like regularly checking your blood pressure or cholesterol levels, you should take a quick cognitive test on an annual basis. They’re quick to take, may pick up something treatable, and may suggest you try new medications that are most effective in the early stages of cognitive impairment. The tests are a good trigger for re-evaluating your lifestyle and making healthy changes.

But assuming your physician doesn’t regularly offer you such a test, what might prompt the conversation about administering one to you or a loved one? Symptoms may likely arise that set off alarms. While everyone slows a bit as we get older, such symptoms as short-term memory loss, difficulty completing familiar tasks, problems with words or language, changes in mood, or misplacing items are not normal. Taking a cognitive test- and not doing well- suggests that something more than “normal” aging may be occurring and more in-depth investigation is warranted. While a poor score on a cognitive test does not automatically translate into an early dementia diagnosis (there are many reasons you could test poorly, including infection, the effects of medication, or some other underlying illness), it does mean that further physical and neurological testing is appropriate, along with blood work and other diagnostic tests. 

So what kinds of cognitive tests are available? There are a multitude of easy-to-administer tests that can be conducted in your primary care physician’s office, including the Mini Mental Status Exam,  the Mini-Cog exam, and the Montreal Cognitive Assessment. Research from the Wexner Medical Center of Ohio State University recently reported that using the easy-to-self-administer SAGE test led to a 6-fold increase of cognitive disorders being identified in the offices of primary care physicians. Other new cognitive assessments that are easy to use are also now being tested, as researchers and companies rush to take advantage of new drugs that may help patients in the early stages of cognitive impairment and search for ways to screen more people. For example, a recent study published in Nature Medicine described a 5-minute picture-based test that accounts for cultural differences and can be embedded in an electronic health record. Whatever test your primary care physician uses, it will be a snapshot of your current status and perhaps (though not necessarily) a harbinger of things to come. If you’re “test curious” take a look at a recent Washington Post article that gives you a taste of what a cognitive assessment would be like.