What Cognitive Tests Can Demonstrate—and What They Can’t

Cognitive Tests: Assessing Brain Health and AgingCognitive Tests: Assessing Brain Health and Aging What are Cognitive Tests? Cognitive tests are short screening tools used to assess various brain functions. They typically involve questions that test memory, language, attention, concentration, and spatial awareness. Two common tests are the MMSE (Mini-Mental State Exam) and MoCA (Montreal Cognitive Assessment). Reliability of Cognitive Screenings Cognitive screenings are not diagnostic tests. A poor score may indicate a need for further evaluation, but a good score does not rule out cognitive problems in highly educated individuals. They provide a snapshot of a person’s cognitive performance at a specific time. When and How Often Should Cognitive Screenings Be Done? Cognitive screenings are recommended as part of annual Medicare wellness visits for people 65 and older. They can also be performed when concerns arise about cognitive functioning. Regular checkups are important for monitoring changes in cognitive abilities. Differences between Cognitive Tests and Neurological Exams Cognitive screenings are often performed by primary care physicians, while neurological exams are typically conducted by specialists. Neurological exams involve a detailed physical examination of speech, reflexes, muscle tone, and function. They can help identify underlying medical conditions that may affect cognitive function. Intensive Neuropsychological Testing If cognitive concerns are identified, a neuropsychologist may conduct a more intensive neuropsychological test. This involves a comprehensive interview and assessments of specific brain functions, using puzzles, object manipulation, and writing tasks. Blood tests and brain scans may also be ordered for further diagnosis. Cognitive Problems vs. Aging Cognitive decline is a normal part of aging. However, problems with memory, thinking, or reasoning that significantly interfere with daily life may indicate a medical condition. Slowing down in cognitive processing speed is expected, but significant difficulties or errors in task completion can be a cause for concern. Seeking Professional Help Individuals with concerns about their memory or cognitive abilities should consult with a doctor or specialist. They can evaluate the underlying causes and develop a treatment plan or provide reassurance.

WASHINGTON — It’s the new slogan in Washington politics: “Take a cognitive test!”

Political opponents, public opinion pundits and even nervous supporters are demanding that President Joe Biden undergo such a test after his poor performance at the debate, even though his doctor says he undergoes and passes an annual neurological exam.

Former President Donald Trump, who is only a few years younger, has made his own gaffes. He recently bragged about passing a cognitive test in 2018 while misnaming the doctor who administered the test.

With all the concerns, what can cognitive tests actually tell you about a person’s brain health—and what can’t they answer? And presidents aside, does the average older adult need one?

What are cognitive tests?

They are short screening tools, a series of 10-minute questions to assess various brain functions. Two of the most common are the MMSE, Mini-Mental State Exam, and the MoCA, Montreal Cognitive Assessment.

Remembering 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 backwards by 7 seconds tests attention and concentration. Drawing a clock with the correct time is a clue to spatial awareness.

The White House memo released from President Joe Biden’s physician, Kevin C. O’Connor, to White House press secretary Karine Jean-Pierre is pictured Monday, July 8, 2024, in Washington. Political opponents, pundits and even nervous supporters are demanding that President Joe Biden undergo cognitive testing after his poor debate performance, even though his doctor says he undergoes and passes an annual neurological exam. Credit: AP/Jon Elswick

How reliable are cognitive screenings?

They do not diagnose health problems. A poor score is merely a warning sign that more testing is needed to see if there is a health problem and to discover what kind, says Dr. James Galvin, a neurologist at the University of Miami.

A good score is usually good news. But especially highly educated people are often good test candidates, even if cognitive problems are starting to develop. So if someone gets a good score, but he/she, a family member or the doctor sees a daily care, then more testing can be done.

“We just use it as a benchmark to determine our level of suspicion,” Galvin said.

When and how often should cognitive screenings be performed?

“A screening test is just a snapshot in time. So it tells you at that moment how someone is doing on that test,” Galvin emphasized. “It doesn’t tell you how someone is functioning in their daily life.”

Reporting a concern is reason enough for a GP to perform one, but it is also part of the annual Medicare wellness visit for people 65 and older.

Galvin wouldn’t discuss Biden or Trump because he hasn’t studied them — but said it’s generally a good idea for seniors to get annual checkups to watch for changes. It’s like how doctors don’t assume your blood pressure is still good, they measure it.

How does a cognitive test differ from a neurological exam?

Cognitive screenings are “pencil and paper tests” typically performed by primary care physicians, while neurological exams are typically performed by a specialist, Galvin said.

It is a very detailed physical exam. Doctors look at the patient’s speech patterns and behavior, test how important nerves are functioning, check reflexes that can signal brain disorders, and assess muscle tone and function.

If either type of test reveals genuine cognitive concerns, the next step may be a more intensive neuropsychological test, an examination that often takes up to three hours.

After an extensive interview with the patient and any accompanying family members, the neuropsychologist administers tests and tasks designed to assess specific brain functions — intelligence, memory, verbal ability, problem-solving and reasoning skills, visual and auditory responses, emotion and mood. They may use puzzles, rearranging objects, or drawing and writing tests.

Blood tests and brain scans may also be ordered. Special types of PET scans can detect the characteristic amyloid plaques and tau tangles in Alzheimer’s brains. An MRI can detect previous strokes, which is helpful in diagnosing vascular dementia.

How do you know if cognitive problems are a disease or just a consequence of aging?

“As we get older, we do things a lot slower,” Galvin said. “We move slower. We think slower. But we still move correctly and we still think correctly — it just takes longer.”

Examples of slower cognitive ‘processing’ might include having trouble remembering a name, numbers, or specific details under pressure – but these will come back to you later.

Galvin noted that reversible health problems sometimes mimic cognitive problems. Urinary tract infections, for example, are notorious for causing sudden confusion in older people. Certain medications affect memory, as do thyroid problems, depression and even poorly controlled diabetes.

Anyone concerned about their memory should talk to their doctor or seek out a specialist, “who can reassure you that everything is OK or develop a treatment plan specific to you,” he said.


The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.


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