It鈥檚 the new chant in Washington politics: 鈥淕et a cognitive test!鈥�
Political opponents, armchair pundits and even nervous supporters are demanding that U.S. President Joe Biden undergo such testing after his dismal debate performance 鈥� even though his physician says he gets, and passes, an annual neurologic exam.
Former President Donald Trump, who鈥檚 only a few years younger, makes his own gaffes. He recently bragged about passing a 2018 cognitive test 鈥� while calling the doctor who administered it by the wrong name.
With all the concern, what can cognitive testing actually tell about a person鈥檚 brain health 鈥� and what can鈥檛 they answer? And presidents aside, does the average older adult need one?
What are cognitive tests?
They鈥檙e brief screening tools, a 10-minute series of questions to assess different brain functions. Two of the most common are called the MMSE, Mini-Mental State Exam, and the MoCA, Montreal Cognitive Assessment.
Recalling a list of five unrelated nouns or seeing how many words beginning with F you can say in a minute can assess short-term memory and language. Counting backward by 7s tests attention and concentration. Drawing a clock with the correct time is a clue to spatial awareness.
How reliable are cognitive screenings?
They don鈥檛 diagnose health problems. A bad score is just a red flag that indicates a need for further testing to see if there is a health problem and uncover what kind, said Dr. James Galvin, a neurologist at the University of Miami.
A good score usually is good news. But the highly educated especially tend to be good test-takers even if cognitive trouble is starting to brew. So, if someone scores OK, yet they, a family member or the doctor sees some day-to-day concern, more testing still could be warranted.
鈥淲e simply use it as a benchmark to determine our suspicion level,鈥� Galvin said.
When and how often should cognitive screenings be done?
鈥淎 screening test is exactly a snapshot in time. So, it tells you in that moment how someone does on that test,鈥� Galvin stressed. 鈥淚t doesn鈥檛 tell you how a person is functioning in their everyday life.鈥�
Simply reporting a concern is reason enough for a primary care doctor to perform one. But it鈥檚 also supposed to be part of the annual Medicare wellness visit for those 65 and older.
Galvin wouldn't discuss Biden or Trump because he hasn't examined them 鈥� but said that generally it's a good idea for seniors to get checked yearly to spot changes. It's much like how doctors don鈥檛 assume your blood pressure鈥檚 still fine, they measure it.
How is a cognitive test different from a neurologic exam?
Cognitive screenings are 鈥減encil and paper tests鈥� usually handled by primary care doctors, while neurologic exams generally are performed by a specialist, Galvin said.
It鈥檚 a very detailed physical exam. Doctors watch the patient鈥檚 speech patterns and behavior, test how key nerves are functioning, check reflexes that can signal brain diseases and assess muscle tone and function.
If either kind of test signals real cognitive concerns, the next step may be more intensive neuropsychological testing 鈥� an exam that often lasts up to three hours.
After an exhaustive interview of the patient and any accompanying family members, the neuropsychologist goes through tests and tasks designed to check specific brain functions 鈥� intelligence, memory, verbal ability, problem-solving and reasoning skills, visual and auditory responses, emotion and mood. They may use puzzles, objects to rearrange, or drawing and writing tests.
Blood tests and brain scans also may be ordered. Special types of PET scans can detect Alzheimer鈥檚 hallmark amyloid plaques and tau tangles in the brain. An MRI can detect past strokes, helpful in diagnosing vascular dementia.
How can you tell if cognitive concerns are a disease or just getting older?
鈥淎ge makes us do things a lot slower,鈥� Galvin said. 鈥淲e move slower. We think slower. But we鈥檙e still moving correctly and we鈥檙e still thinking correctly 鈥� it just takes us longer.鈥�
Examples of slower cognitive 鈥減rocessing鈥� might be difficulty remembering a name, numbers or specific details under pressure 鈥� but they come back to you later.
Galvin noted that sometimes, reversible health problems mimic cognitive trouble. For example, urinary tract infections are notorious for causing sudden confusion in older people. Certain medications affect memory, as can thyroid problems, depression, even poorly controlled diabetes.
Anyone who's worried about their memory should talk to their doctor, or seek a specialist, 鈥渨ho can reassure you that everything's OK or develop a treatment plan that's specific for you,鈥� Galvin said.
