The Truth About Cognitive Tests: Surprising Facts

Two decades ago, during a particularly stressful period in her mid-40s, the author felt her memory slipping away. She struggled to recall simple words and phrases, which fueled her anxiety and worsened her cognitive issues. Fearing a brain tumor, she consulted her primary care doctor.

During the examination, the doctor asked basic questions like the current year and the date, which the author answered correctly. However, she stumbled when asked to spell “world” backward and to count backward by sevens from 100. Overwhelmed with anxiety, she broke down, convinced she had a serious condition.

The doctor reassured her that she did not have a brain tumor or cognitive deficit but diagnosed her with an anxiety disorder. She was prescribed medication and advised to start meditation.

This experience reflects a broader concern: a 2020 study found that two-thirds of Americans experience some level of cognitive decline by age 70, with women facing a 37% lifetime risk of dementia. The risk varies by education and socioeconomic status, with disadvantaged groups experiencing earlier onset and more severe symptoms. Race and ethnicity also play a role, with White women typically experiencing fewer years of cognitive impairment compared to Black women and Latinas.

Unbeknownst to her, the author’s doctor used the Mini-Mental State Exam (MMSE), a widely used tool for assessing cognitive impairment. While useful, MMSEs are not diagnostic and only provide a general sense of cognitive function.

Ronald Petersen, a neurologist at the Mayo Clinic, explains that these assessments are like blood pressure readings—they offer a metric of cognitive function but do not diagnose specific conditions or pinpoint the exact issues in the brain.

Stephen Rao, director of the cognitive neuroimaging center at Cleveland Clinic, recommends annual cognitive assessments for individuals over 65. These assessments measure various cognitive functions and can lead to more advanced testing if abnormalities are detected. Tests might include MRI or PET scans, lumbar punctures, or blood biomarker tests to detect early signs of Alzheimer’s disease.

Medicare covers cognitive assessments during annual wellness visits, but many primary care doctors lack the expertise to administer and interpret these tests effectively. A recent poll indicated that while 80% of older adults see the benefit of these assessments, 80% have not been tested in the past year, and 59% have never undergone one.

Normal aging includes occasional forgetfulness, such as forgetting names or misplacing items. However, more concerning signs include forgetting close family members' names, having trouble managing finances, or frequently getting lost. Cognitive assessments are crucial for identifying such issues, as they can reveal treatable conditions affecting memory.

Many avoid cognitive assessments due to privacy concerns or fear of unfavorable results. Yet, about 40% of dementia cases can be either reversed or slowed if detected early. Screening can also uncover other treatable causes of cognitive decline, such as blood clots, medication side effects, sleep issues, and nutrient deficiencies. The author plans to request a cognitive assessment during her next wellness visit, having learned strategies to handle the tests more effectively.