Assessment
What You Need to Know About Cognitive Testing
Duke Han explains the different kinds of brain function tests, and why all older adults might want to get a screening
MICROGEN IMAGES/SCIENCE PHOTO LIBRARY / Getty Images
Has your doctor recommended that you get a cognitive assessment? The idea of an evaluation that measures your thinking skills, memory, attention and reasoning — knowing there’s a possible dementia diagnosis on the other side — can be scary.
We spoke to Duke Han, professor of psychology, family medicine, neurology and gerontology at Keck School of Medicine at USC, about what’s usually involved in cognitive screening as well as more in-depth cognitive testing. Han is a long-time member of AARP’s Global Council on Brain Health.
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Medicare generally covers basic cognitive screening as part of a beneficiary’s annual wellness visit for people ages 65 and older, but many older adults are not taking advantage of it. Han says you might consider asking for cognitive screening starting in your 50s, even if you’re feeling perfectly fine. Here’s how he answered our questions.
This interview was edited for clarity and length.
What is cognitive testing?
Cognitive testing measures someone’s cognitive ability — thinking skills, memory, attention, reasoning — with respect to others of their age and, sometimes, their demographic background. This is helpful when we are trying to understand whether someone is functioning at an expected level, or if there might be an impairment of some sort.
What is involved in cognitive testing?
There are different levels, depending on the person’s needs. There is a very basic cognitive evaluation generally called a cognitive screen, and a more detailed, comprehensive evaluation called cognitive testing. A cognitive screen, such as the MoCA test, is short and may not pick up on things that the lengthier test would.
Many doctors who are not trained neuropsychologists will often give cognitive screens. If a cognitive screen suggests impairment, deeper cognitive testing may be the next step.
More comprehensive cognitive testing is done by clinical neuropsychologists, who conduct very thorough evaluations of cognitive abilities. These evaluations are helpful, for example, if someone is starting to experience some sort of cognitive decline. We can help figure out why that is happening. Cognitive decline can be caused by a dementia condition, or it can be the result of a change in lifestyle or the effect of a medication.
A full evaluation can range from one hour to six hours. If someone only had memory problems, they might undergo a shorter test than they would if, for example, they had memory problems plus issues with reading and attention. Tests may also be longer if someone has a neurological condition, such as epilepsy.
Who should get a cognitive test?
Anyone who’s experiencing a change in their thinking or memory. We all misplace our keys and forget where we put them. Often that happens because we’re just not paying attention. If someone’s having trouble on a consistent basis with things like where they parked their car or ongoing lapses in memory, it could be time to get an evaluation.
Many in our field also feel that, even if you’re not experiencing a cognitive decline or concern, getting this evaluation done when you’re feeling pretty good helps create a baseline against which other tests might be compared at a future time. One of the most beneficial pieces of information to help determine whether someone is experiencing cognitive decline is having an available baseline. So getting an evaluation when someone’s feeling good is a good idea.
What’s involved in the deeper evaluation?
Typically there’s an interview portion that can take the better part of an hour. In that interview, the doctor is asking questions about various aspects of the patient’s life. After that, the testing portion depends on what the concerns are. These evaluations are typically done on an outpatient basis.
The post-interview tests can be pencil-and-paper or digital, and they test a range of abilities: visual-spatial ability; language ability; memory; and, of course, attention abilities. It’s meant to be a very broad and detailed assessment of someone’s cognitive abilities, so we can see the strengths and weaknesses. Some of those tests will feel like school exams, and some will feel like playing games. Some will ask the participant to draw pictures. The tests are designed in such a way that if someone’s not a great drawer, it’s fine. They take those things into consideration.
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What will the results show?
Everyone will get a pattern of strengths and weaknesses when it comes to their cognitive ability. You won’t get that with a [basic cognitive screening] MoCA test, which only provides a score that indicates whether or not there’s suspected impairment. A clinical neuropsychologist generates a report for every patient that contains details about cognitive strengths and weaknesses and recommendations for maintaining or improving cognitive ability.
Everyone thinks cognitive testing is just the MoCA. That is a very general screening test, and it’s not the more detailed evaluation. It will only test certain cognitive functions in a shallow manner. The broader and deeper evaluation will produce a pattern of results that will more accurately inform diagnosis and treatment options.
What’s your number one piece of advice for someone about to undergo cognitive testing?
Getting a good night’s sleep is a good thing. If someone’s going into a session very distracted or very tired, they’re not going to perform to the best of their ability and that’s really important on these tests. If people aren’t performing at their best, it’s hard to interpret the results.
Read more from Staying Sharp about how to talk to your doctor about brain health.
And take the Cognitive Assessment at no cost to understand how you’re performing today. Our science-based assessment tests core areas like memory and attention and processing speed, and it’s available for free on StayingSharp.org. You’ll need to register, and the assessment takes about 20 minutes.
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