Add Cognitive Testing to Your Annual Health Checks

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With mild cognitive impairment (MCI) in the news recently, I set out to understand a little about cognitive testing and what it can do for us. MCI is the term used to describe changes in cognition that are serious enough to be noticed, yet don’t necessarily impact a person’s everyday functioning.

According to a recent report released by the Alzheimer’s Association, 12-18% of people age 60 or older are living with MCI.* Yet fewer than one in five Americans are familiar with the condition. And now we are learning that individuals with MCI may have a higher risk of developing dementia. Studies estimate that 10-15% of individuals with MCI go on to develop dementia each year.

Professionals in brain health fields are concerned, also, with a lack of familiarity with MCI. 55% of U.S. adults surveyed, when prompted with a description of MCI, confuse it with normal aging. But MCI is not normal aging. It’s also not quite dementia.

According to Kelly Ostoff, Senior Director of Programs at the Alzheimer’s Association Colorado Chapter, “It’s really important to understand the difference between normal cognitive aging and symptoms of MCI or dementia that fall outside of normal range. For example, it’s normal to forget a name from time to time, if you are able to recall it later.” The Alzheimer’s Association’s Ten Early Signs and Symptoms of Alzheimer’s [sidebar] is a good place to start when curious about changes in memory, thinking, or reasoning skills that could be connected to brain disease.

Experts are quick to point out that dementia is a symptom connected to brain health. It’s not in itself a disease. It can be connected to a whole host of underlying causes including vitamin deficiency, medication side effects or interactions, and even urinary tract infections. So, tuning into signs of MCI and dementia as early as possible allows for uncovering root causes in time to proactively address them.

Like other aspects of our health, routine screenings are one way to catch brain disease processes early on. According to Ostoff, “The Alzheimer’s Association recommends routine cognitive testing starting at age 65. Anyone insured by Medicare is eligible for this screening as part of their Medicare Annual Wellness Visit, provided by their own doctor. And if their doctor isn’t comfortable providing the assessment, they can refer the patient to another provider, whether it’s a general practitioner or a specialist.”

“And it’s important,” Ostoff continues, “for someone to seek cognitive testing sooner if they’re noticing cognitive changes. Also, if a person has a family history of dementia or has a known genetic indicator for Alzheimer’s Disease, they can begin routine cognitive assessments at an earlier age.”

Joanna Brooks Fix, a volunteer with the Alzheimer’s Association Colorado Chapter, first visited a neurologist in her early 40s. She was concerned by changes that were interfering with her work as a university professor. “When you don’t know what you’re dealing with, it’s like you’re sitting at a red light forever,” she said in a first-person account provided by the chapter. “The worst thing that can happen (for a person living with Alzheimer’s) is not knowing. You have to keep going until you get an answer. Life is better when you know what you’re facing.”

Fix points to one of the key advantages of early detection: knowledge. When survey respondents were asked specifically about reasons for seeking an early-stage Alzheimer’s diagnosis (versus waiting until a later stage), knowledge rose up as most important. 70% said “it would allow me and my family to plan for the future” and “it would allow for earlier treatment of symptoms.” Over 60% said “I could begin health measures to preserve existing function” and “it would help me understand what is happening.”

Routine screening typically takes place in a primary care setting and consists of a three to five-minute set of questions and tasks like those in the General Practitioner Assessment of Cognition (GPCOG) and Mini-Cog. You might encounter the longer Montreal Cognitive Assessment (MoCA), which takes 10-12 minutes for its 30 questions. A range of health care providers are certified to conduct this assessment, so you might find yourself being offered one by a speech therapist, for example, or when in the hospital for some other reason.

If you’re exhibiting symptoms, such as MCI or dementia, testing shifts toward gathering as much information as possible in order to carefully narrow down the field of possible causes. A neurologist may look to a PET/CT scan or MRI to establish a baseline, or to rule out brain tumor, subdural hematoma, or stroke.

Your doctor may want to add input from your friends or family through tools like the Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8). These are extremely helpful because—let’s face it—if you’re experiencing symptoms of cognitive decline it may be hard for you to recount changes in your own condition that have taken place over several years.

Surveys that explore general conceptions of MCI reveal that doctors, too, are working to better understand it. They’re strengthening their in-office screening tools and forming better relationships with specialists. We can meet our doctors halfway by asking about routine testing and by sharing openly and proactively about any changes we’re noticing.

Ten Early Signs and Symptoms of Alzheimer’s From the Alzheimer’s Association

1. Memory loss that disrupts daily life

2. Challenges in planning or solving problems

3. Difficulty completing familiar tasks 

4. Confusion with time or place

5. Trouble understanding visual images and spatial relationships

6. New problems with words in speaking or writing

7. Misplacing things and losing the ability to retrace steps

8. Decreased or poor judgment

9. Withdrawal from work or social activities

10. Changes in mood and personality

* Data in this article taken from “Special Report–More Than Normal Aging: Understanding Mild Cognitive Impairment,”

 Visit the expanded version of this list online to learn about typical age-related changes in each of these areas.

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