What Happens During a Cognitive Test at the Doctor's Office?
When an older adult begins having problems with memory or thinking, a doctor may recommend a cognitive assessment. These are short tests that look at how well a person remembers information, pays attention, solves problems, uses language, and understands the world around them.
Cognitive tests do not hurt, and they usually do not require special equipment. Most involve answering questions, remembering words, drawing something, or completing simple tasks.
It is important to remember that these tests are not school exams that someone either passes or fails. Their purpose is to provide health care professionals with useful information about how a person's brain functions and whether further evaluation could be helpful.
Most importantly, a cognitive screening test does not diagnose Dementia on its own. Results may indicate a problem that warrants closer examination. Doctors then consider the results along with the person's medical history, medications, daily abilities, physical health, and other information.
Two tests that people may encounter are the Mini-Cog and the Montreal Cognitive Assessment, or MoCA.
The Mini-Cog
The Mini-Cog is a very short screening test. It usually takes about three minutes. It combines a memory task with a clock-drawing task.
First, the doctor gives the person three words to remember. The person repeats the words so the doctor knows they heard them correctly.
Next comes the clock-drawing test. The person is asked to draw a clock, place the numbers in the correct positions, and set the hands to a specific time. Drawing a clock may sound easy, but it requires the brain to perform several jobs at once. A person must understand the directions, remember what a clock looks like, organize the numbers, and correctly position the clock hands.
After drawing the clock, the person is asked to recall the three words from earlier.
The doctor scores the word recall and clock drawing. A lower score may suggest that additional evaluation is needed.
However, a Mini-Cog result is not a diagnosis of Alzheimer's disease or another Dementia. It is a screening tool that helps doctors decide whether they should investigate further.
The MoCA
Another commonly used assessment is the Montreal Cognitive Assessment (MoCA). It is more detailed than the Mini-Cog and examines several types of thinking skills.
The MoCA generally takes about 10 minutes to administer and is scored out of 30 points.
During the test, a person may be asked to complete several activities to evaluate attention, language, executive function, and orientation to time, location, and date. For example, the person may be shown pictures of animals and asked to name them. They may hear a list of words and be asked to remember them later, or be asked to work with numbers.
Other Cognitive Tests
Doctors have several other tools available that you may hear about:
What Happens After a Cognitive Test?
A concerning test result does not automatically mean that a person has a form of Dementia. Many conditions can affect thinking and memory. These may include medication side effects, depression, sleep problems, thyroid problems, vitamin deficiencies, infections, and other medical conditions.
The doctor may therefore review medications, perform a physical or neurological examination, order blood tests, or ask additional questions about the person's ability to handle everyday activities.
In some cases, the doctor may recommend more detailed testing with a neurologist, geriatrician, or neuropsychologist. Brain imaging, such as an MRI or CT scan, may also be considered.
Cognitive screening is best viewed as one piece of a larger puzzle. It helps doctors identify changes that deserve attention and determine what should happen next, and for families, knowing what to expect can also make the process less intimidating.
Sources
Alzheimer's Association. “Cognitive Screening and Assessment.
Alzheimer's Association. “Medical Tests for Diagnosing Alzheimer's & Dementia.”
National Institute on Aging. “Assessing Cognitive Impairment in Older Patients.”
National Institute on Aging. “Cognitive Assessment Considerations: Understanding the Evidence.”
National Institute on Aging. “How Is Alzheimer's Disease Diagnosed?”
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