July 30, 2024 – With the term “cognitive testing” now a part of on a regular basis conversation, brain health experts welcome the possibility to elucidate exactly what these tests can and can't do.
Although there are several types of cognitive tests, “we are talking about [often] are primarily cognitive screening tests,” says Joe Verghese, a cognitive neurologist and department head at Montefiore Medical Center in the Bronx, New York. He holds the English equivalent of a medical degree.
While people think the tests are the answer to whether they have dementia, Verghese said they alone do not provide a diagnosis. “They are designed to determine whether someone is at higher riskfrom mild cognitive impairment,” he said.
With mild cognitive impairment, older people have more problems with considering or memory than their peers. These individuals are at higher risk of developing dementia, but not necessarily.
The commonest basic cognitive screening tests include:
- Montreal Cognitive Assessment: This test requires you to memorize a brief list of words, name objects shown in pictures, copy shapes, and complete other tasks. Duration: quarter-hour.
- Mini-Mental State Exam (MMSE): Counting backwards, identifying objects in a room, stating the date, and other known information. Time: 10 minutes.
- Mini Gear: Memorize after which recall a listing of three unrelated words. Draw a circular clock (add deadlines and draw hands to represent a selected time). Time: 3 minutes.
Since these basic screening tests are so quick and straightforward, should older adults take such a test? In a 2020 suggestion, the US Preventive Services Task Force said there may be an absence of evidence to weigh the advantages and harms of comprehensive screening for cognitive impairment in older adults ages 65 and older, and more research is required. The task force is an independent, volunteer panel of experts that makes evidence-based recommendations on clinical prevention measures resembling testing.
What happens after the screener?
Failing any of the cognitive screening tests doesn't mean you've dementia, but it surely does indicate that further testing is required, Verghese said.And should you pass the test with flying colours? “If you pass, it doesn't mean you're completely normal, it just means you're less likely to develop dementia.”
If the rapid tests raise concerns, doctors will move on to more extensive diagnostic tests that may take one to 3 hours and examine brain function in additional detail, Verghese said.
“It's not practical to screen everyone with a 3-hour test,” Verghese said. These tests are intended for older patients who are available with cognitive problems or when the family of older patients raises concerns. The 65-year-old limit is unfair, Verghese said. A 65-year-old could, after all, be cognitively and physically healthy, while a 55-year-old may very well be frail.
It's essential to differentiate between the 2 forms of tests, said Dr. Shehroo Pudumjee, a neuropsychologist on the Cleveland Clinic's Lou Ruvo Center for Brain Health in Las Vegas. The easy tests “are very quick, but they're screenings, not comprehensive tests,” she said. They're designed to detect cognitive impairments, but they're not very specific.
The comprehensive exam depends heavily on the patient, she said, so it's not possible to offer a precise list of what's included. It should start with a comprehensive medical history, including questions on medications (resembling antihistamines for colds or for sleeping) or medical conditions (multiple sclerosis, depression, concussions) that may affect mental performance.
Health care providers would also ask family and other relatives what they notice about cognitive problems, how the person sleeps and other details. Next, Pudumjee said, cognitive testing would more closely examine an individual's considering, memory and other brain functions.For example, the thesaurus can be more demanding than within the screener.
The results could indicate a severe cognitive disorder resembling Alzheimer's or one other dementia, or one other disease resembling Parkinson's or multiple sclerosis, Pudumjee said.
Who passes the tests with flying colours?
In a recent study In the United Kingdom, researchers studied nearly 27,000 people between the ages of 53 and 86 and located that night owls performed higher on cognitive function tests than morning owls. They also found an association between normal sleep duration of seven to 9 hours and higher cognitive outcomes.
To do well on the tests, an important thing is just to get enough sleep, Verghese said, noting that some older people can have sleep problems and lack of sleep is a risk factor for dementia.
New options
To help primary care physicians discover cognitive problems of their patients, Verghese and colleagues recently developed a test called the 5-Cog Paradigm, a straightforward, five-minute assessment coupled with recommendations integrated into the electronic health record system to enhance diagnosis and treatment.
In the Research, Verghese and his colleagues studied 1,201 primary care patients with cognitive problems. The average age was slightly below 73 years. They were either assigned to the brand new test or assigned to a control group that didn't receive it.
Over the subsequent 90 days, those that took the test were 3 times more likely than those that didn't take the test to profit from improved dementia care interventions, resembling receiving a diagnosis of mild cognitive impairment or dementia, being referred to specialists, or receiving helpful medications.
The test features a picture-based screening test for memory impairment, a transient picture-based symbol comparison, and confirmation that the patient has cognitive complaints.
Primary care physicians are sometimes the primary to discover patients with cognitive problems, Verghese said, but they are sometimes busy treating patients' other diverse health problems, making the rapid test precious.
If providers don't charge patients for it, it's accessible from Montefiore, he said.
Vocal cues for cognitive fitness
Voice biomarkers – resembling speech rate and pause length – could also be becoming increasingly precious in detecting cognitive impairment, in accordance with a study presented Monday on the Alzheimer's Association's International Conference in Philadelphia. Researchers at Montefiore Medical Centerand Sonde Health, a voice-based health tracking company, reported the outcomes of a cognitive screening and voice evaluation of greater than 200 people and located that the voice evaluation was consistent with conventional testing.
Because voice-controlled devices are so widespread, automated voice evaluation may very well be helpful in detecting and monitoring cognitive impairments early, the researchers said. Sonde Health already offers firms trackers for mental and respiratory fitness; with Sonde Cognitive Fitness, the corporate has expanded its options. The program examines eight voice characteristics from 30-second voice interactions and creates a rating that gives feedback on an individual's cognitive state.
Do-it-yourself cognitive tests?
Numerous cognitive do-it-yourself tests can be found online. One of them known as SAGE, for self-administered gerocognitive assessment was developed at Ohio State University. Users are encouraged to download it, fill it out, after which bring it to their doctor for evaluation.
The test typically takes about quarter-hour and requires users to reply basic medical history questions, complete basic math problems, discover on a regular basis objects, copy a straightforward drawing, and draw and complete a clock.
The assessment by a physician is crucial, said Verghese. “A test without a follow-up examination is not advisable,” he said.
Allay concerns
Don't ignore concerns about cognitive health, Verghese said. “If you have cognitive concerns or notice cognitive concerns in a loved one, go for a screening test,” he said. “In most cases, it can turn out to be normal aging, in this case [the result] is reassuring.”
And if a cognitive problem is identified? “It's very essential to catch it early,” he said. Treatments or prevention strategies may give you the chance to assist.