WASHINGTON – It’s the new cry in Washington politics: “Take a cognitive test!”
Political opponents, armchair experts and even nervous supporters demand that President Joe Biden pass these tests after his dismal debate performance — even though his doctor says he takes and passes an annual neurological exam.
Former President Donald Trump, who is just a few years younger, makes your own mistakes. He recently bragged about passing a 2018 cognitive test — while calling the doctor who administered it by the wrong name.
For all the concern, what can cognitive tests really tell us about a person’s brain health — and what can’t they answer? And, presidents aside, does the average senior need one?
They are brief screening tools, a series of 10-minute questions to assess different brain functions. Two of the most common are called the MMSE, Mini-Mental State Exam, and MoCA, Montreal Cognitive Assessment.
Remembering a list of five unrelated nouns or seeing how many words starting with F you can say in a minute can assess short-term memory and language. Counting backwards from 7 to 7 tests attention and concentration. Drawing a clock with the correct time is a clue to spatial awareness.
They do not diagnose health problems. A bad score is just a warning sign that indicates the need for more testing to see if there is a health problem and find out what kind, said Dr. James Galvin, a neurologist at the University of Miami.
A good score is generally good news. But especially the most educated tend to be good test candidates, even if cognitive problems are beginning to emerge. So if someone has a good score, a family member or doctor notices a concern in their day-to-day life, further testing may still be needed.
“We simply use that as a benchmark to determine our level of suspicion,” Galvin said.
“A screening test is exactly a snapshot in time. So, in that moment, it shows how someone performed on that test,” Galvin emphasized. “It doesn’t tell you how a person is functioning in their everyday life.”
Simply reporting a concern is reason enough for a primary care doctor to perform one. But it should also be part of the annual Medicare wellness visit for people 65 and older.
Galvin wouldn’t discuss Biden or Trump because he hasn’t screened them — but said it’s generally a good idea for seniors to be screened annually to detect changes. It’s much like doctors don’t assume your blood pressure is still good, they measure it.
Cognitive exams are “pencil and paper tests” usually performed by primary care doctors, while neurological exams are usually performed by a specialist, Galvin said.
It is a very detailed physical exam. Doctors observe a patient’s speech and behavior patterns, test the function of major nerves, check reflexes that may signal brain disease, and assess muscle tone and function.
If any type of testing flags real cognitive concerns, the next step may be more intensive neuropsychological testing — an exam that typically lasts up to three hours.
After an exhaustive interview with the patient and accompanying family members, the neuropsychologist goes through tests and tasks designed to verify specific brain functions – intelligence, memory, verbal ability, problem-solving and reasoning abilities, visual and auditory responses, emotion and mood. . They may use puzzles, objects to rearrange, or drawing and writing tests.
Blood tests and brain scans may also be ordered. Special types of PET scans can detect amyloid plaques characteristic of Alzheimer’s disease and tau tangles in the brain. An MRI can detect previous strokes, useful in diagnosing vascular dementia.
“Age makes us do things a lot slower,” Galvin said. “We move slower. We think more slowly. But we’re still moving right and thinking right – it just takes us longer.”
Examples of slower cognitive “processing” might be difficulty remembering a name, numbers or specific details under pressure – but they come back to you later.
Galvin noted that sometimes reversible health problems mimic cognitive problems. For example, urinary tract infections are known to cause sudden confusion in elderly people. Certain medications affect memory, as do thyroid problems, depression, and even poorly controlled diabetes.
Anyone who is concerned about their memory should talk to their doctor or see a specialist, “who can make sure everything is OK or develop a treatment plan specific to you,” he said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. AP is solely responsible for all content.
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