Cognitive Test

What is a cognitive test?

A cognitive test checks for problems with your mental function (how your brain processes thoughts). The test involves answering simple questions and performing simple tests.

The test is also called a cognitive screening test or cognitive assessment.

What is cognition?

Cognition is your brain’s ability to process all the information it takes in from your senses. Your brain is your body’s thought processing center.

Cognition involves intellectual activities, including:

• Thinking.
• Learning.
• Understanding and using language.
• Remembering.
• Paying attention.
• Reasoning.
• Making decisions.
• Applying judgment.

Why might I need cognitive testing?

Cognitive tests are usually done if there’s a suspicion of mental decline or impairment. You may have noticed such a decline yourself or a close friend or family member may have noticed.

What do cognitive screening tests show?

Cognitive screening tests are simple, quick, basic tests. They help reveal if there’s a problem in some aspect of your cognition.

Cognitive screening tests don’t reveal any information about:

• Why there might be cognitive impairment.
• The location in your brain of the cognitive impairment.
• The condition that might be causing the cognitive impairment.
• The severity of the cognitive impairment.

Based on your score, you may need more in-depth testing. If so, your healthcare provider will order a neuropsychological assessment.

What do poor and good scores on a cognitive test mean?

Poor (low) scores provide more information than good (high) scores. A very low score usually means there’s some brain impairment. But a good score doesn’t necessarily mean there’s no brain impairment. There still could be brain functioning issues.

Are cognitive tests used to diagnose dementia?

Cognitive screening tests aren’t specifically used to diagnose dementia. If your healthcare provider thinks you need more testing or other imaging tests, they’ll order these tests or refer you to a neurologist.

What kinds of questions and tasks are asked in cognitive tests?

Cognitive screening tests check various brain functions. There are many screening tests. Each test checks one or more of the following:

• Knowledge of time, place and person: You’ll be asked the current date, your location and your name.
• Attention and short-term learning: You’ll be asked to recall a short list of items.
• Concentration: You’ll be asked to spell five-letter words forward, then backward.
• Short-term recall: You’ll be asked to recall objects you were shown or sounds you heard a couple of minutes ago.
• Short-term memory: You’ll be asked to describe an event that happened in the past day or two.
• Long-term memory: You’ll be asked to describe an event from the distant past.
• Abstract thinking: You’ll be asked to name the relation between several objects (such as cats, horses, dogs [are all animals]), explain the meaning of a proverb or common saying (such as “actions speak louder than words”) or finish an analogy (such as “glove is to hand as [blank] is to foot”).
• Ability to use language: You’ll be asked to name objects and read, write and repeat phrases.
• Language comprehension: You’ll be asked to perform a simple task that includes a body part and an understanding of right and left (such as, place your right hand on your left knee).
• Ability to understand the relationship between objects or people: You’ll be asked to draw a clock with its hands pointing to a specific time or draw a house.
• Perform a specific action: You’ll be asked to show how to brush your teeth.
• Perform mathematical functions: You’ll be asked to subtract a certain number from a high number and continue subtracting the same certain number from that answer.
• Assess judgment: You’ll listen to a situation and be asked what you’d do. For example, “If you saw a person who was injured, what would you do?”

What are the most common cognitive screening tests?

• Montreal Cognitive Assessment (MoCA): This test involves memorizing a short list of words, naming objects shown in pictures, copying shapes and performing other tasks. This test takes about 15 minutes to complete.
• Mini-Mental State Exam (MMSE): This test involves counting backward, identifying objects in the room, stating the date and other common, well-known facts. This test takes about 10 minutes.
• Mini-Cog: This test involves memorizing and recalling a three-word list of unrelated words and drawing a circle clock — adding all time points, then drawing hands to show a specific time. This test is the shortest (under three minutes) and easiest to complete.

There are many other screening tests. Others include the Memory Impairment Screen (MIS)/MIS by Telephone (MIS-T), Mental Status Questionnaire (MSQ), 8-item Informant Interview (AD8), Functional Activities Questionnaire (FAQ), 7-Minute Screen (7MS), Abbreviated Mental Test (AMT), St Louis University Mental Status Examination (SLUMS), Telephone Instrument for Cognitive Status (TICS) and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

How do I prepare for a cognitive screening test?

You don’t need to prepare for a cognitive screening test. There aren’t any scans or physical tests. There aren’t physical risks, either. You can’t study for these quick, basic tests.

Where do I take this test?

You’ll take these tests in a healthcare setting. They’re usually given by a physician or nurse who may or may not have formal training in brain health. Based on the results of these quick, simple tests, you may need more in-depth testing with a professional trained in brain health.

How is a cognitive screening test used alongside a regular health checkup?

Your healthcare provider usually asks about your medical and medication history before ordering a cognitive screening test. They’ll order lab work and other tests or scans to rule out other causes of mental decline.

Some treatable or reversible conditions that affect mental functioning include:

• Underactive thyroid gland (hypothyroidism).
• Some sleep disorders, including insomnia, sleep apnea and lack of sleep.
• Blood under the outer layer of the membrane that covers your brain (subdural hematoma).
• Medication side effects (such as anticholinergics [for asthma, GI disorders, insomnia], antidepressants, antihistamines [for sleep colds and allergies].
• Extra fluid around your brain (normal pressure hydrocephalus).
• Depression.
• Vitamin B12 or folic acid deficiency.

Possible partially reversible causes of memory loss and cognitive impairment include:

• Stroke.
• Delirium.
• Long-term, long-lasting seizures.
• Multiple sclerosis.
• A repeated head injury like concussions.
• Brain infection, brain tumors.
• Certain drugs, including long-term alcohol use.

Common and nonreversible causes of memory loss and brain function changes include:

• Age-related changes in memory.
• Mild cognitive impairment.
• Dementia or Alzheimer’s disease.

Can I test my cognitive ability myself?

There are some cognitive assessment tests that you or a loved one can take yourself. One such test is the Self-Administered Gerocognitive Exam (SAGE). You can find it on the internet. Like other cognitive tests, it assesses basic orientation (date, month, year), language, reasoning, calculations, visuospatial orientation (clock drawing), problem-solving and memory.

Remember, no cognitive test can diagnose Alzheimer’s disease, dementia or any other specific condition. However, the tests can be a helpful screening tool for mild cognitive impairment.

Taking an at-home cognitive test is a reasonable first step if you think you or a loved one is having trouble with memory, language, problem-solving and thinking.

After completing the test, make an appointment with your healthcare provider. Your healthcare provider can:

• Score the test.
• Discuss the findings.
• Conduct a physical exam.
• Review your medical and medication history.
• Order other tests to rule out conditions that affect memory or thinking.

What is mild cognitive impairment?

Cognitive impairment means you have a problem with cognition (processing thoughts). Mild cognitive impairment means you have a problem with mental function but it’s not severe enough to affect your daily functioning.

Symptoms of mild cognitive impairment include:

• Repeating questions.
• Trouble coming up with the desired words.
• Frequently misplacing items.
• Forgetting appointments or planned events.
• Losing your focus.
• Trouble understanding written or verbal information.

What’s a neuropsychological assessment?

A neuropsychological assessment is an in-depth test given by a trained professional (a neuropsychologist). Neuropsychology determines how well your brain is working. This is the gold standard testing method. It’s a much more complete test than a cognitive test. It takes one to eight hours to complete, although two to four hours is typical.

Mental functions tested include:

• General intellect.
• Reading/reading comprehension.
• Language usage and understanding of what others say.
• Attention/concentration.
• Processing speed.
• Learning and memory.
• Reasoning.
• Executive functions, which are higher-level skills you use to organize and plan, manage your time, problem-solve, multi-task, make judgments and maintain self-control.
• Visuospatial skills.
• Motor speed and dexterity.
• Mood and personality.

Your test results are compared with other test results from people of the same age, gender and years of education. Pooling the results helps identify patterns. The patterns show which part of your brain isn’t working well. The test results also help your healthcare provider make the diagnosis and guide discussion of what you can do to improve your cognition and quality of life.

A note from Cleveland Clinic

Taking a cognitive test and learning the results can be stressful, especially if your score is poor. Knowing your score is only the start of the process, though. You’ll need more testing to learn more. There are many treatable and reversible causes of cognitive impairment. If more testing shows signs of mild cognitive impairment or early dementia, treatment can be started. It also gives you and your family time to understand what to expect in the years ahead and prepare for future needs. Your healthcare team is here to help — to provide support and information, adjust your treatment or explore new options available through clinical trials.