When Should You Get It? What Can It Show?
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Even if you’ve made peace with growing older, the outward signs of aging — graying hair, spotty skin, achy joints — are unavoidable. Likewise for the changes in the parts of the body you don’t see, including the brain.
As early as your thirties and forties, the brain starts to shrink, including the part called the hippocampus, which is important for learning and memory. Aging also causes communication between neurons (nerve cells) to be less effective, blood flow in the brain to decrease, and inflammation to increase.
With these changes, older adults might experience challenges in their thinking like difficulty recalling names or words, or decreased attention; both could just be signs of normal aging.
However, in some people, neurodegenerative changes take place in the brain that are not normal aging, even though they are more likely to occur at an older age. Certain processes in the brain cause the collection of toxic clumps of proteins called amyloid. Amyloid permits another toxic protein called tau to injure and kill neurons and cause true memory loss, including being unable to recall recent details, events, or conversations. This type of memory loss can be an early sign of mild cognitive impairment (MCI), dementia, or Alzheimer’s disease.
Why Get a Cognitive Screening?
There are many good reasons to get screened for cognitive impairment. For starters, it can pick up changes in your memory or thinking functions before you start to have significant difficulties. In many cases, the changes could be due to an underlying (and fixable) cause, such as a side effect of certain medications or nutritional deficiencies.
For people with the early stages of dementia, new drugs have been shown to slow down progression of the disease, and lifestyle changes may do the same, says Maryjo Cleveland, MD, a gerontologist who specializes in Alzheimer’s disease and dementia at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina.
But when is a good time to get screened for cognitive decline, and what do you do with the information once you have it? Here’s what you need to know about when to get screened for cognitive changes, where to get screened, and what to do with the results.
What Is Cognitive Screening?
A cognitive assessment tests various aspects of a person’s cognitive functioning, with the goal of detecting any early signs of memory loss or difficulty with thinking, problem-solving, language, or other cognitive functions.
People with early cognitive changes often either aren’t aware of them or may deny what they’re experiencing.
The screening is typically a questionnaire or brief assessment, says Dr. Cleveland. “A screening is not used to make a diagnosis, but rather a preliminary step to identify individuals who may need further evaluation by healthcare professionals,” she says.
Cleveland compares it to other types of health screenings you may get during a yearly wellness check: “A cognitive screening is used to check to see if you might be at risk for dementia, just as you would get your cholesterol level checked to find out if you’re at risk for cardiovascular disease.”
Should I Wait Until Changes in My Memory or Thinking Are Noticeable to Get Screened?
No, says Cleveland. “If someone comes in and says, ‘I’m having terrible memory problems or I keep forgetting to take my medicines,’ we’re going to do a diagnostic evaluation at that point,” she says.
With a screening, you’re looking for something that’s not clinically apparent — you don’t need to have noticeable declines in memory or cognition to get one, she says.
Is There a Recommended Time to First Get a Cognitive Screening?
Once you enroll in Medicare, usually at age 65, a basic cognitive screening test is supposed to be included in the annual wellness visit to see if you have any cognitive impairments, says Cleveland.
“For people who haven’t had any symptoms, I think 65 years old is a reasonable age to begin getting screened,” she says.
Some research shows, however, that not all Medicare beneficiaries take advantage of the annual wellness visit and, of those who do, not all report having a cognitive assessment at that visit.
Can My Primary Care Doctor Perform a Cognitive Screening?
Yes. Cleveland recommends getting screened for cognitive changes in your primary care doctor’s office. “There are not enough specialists on the planet — geriatricians or neurologists — to screen everyone in a timely manner,” she says.
Your primary care doctor is also the logical choice because a patient’s history and physical exam should be part of a cognitive assessment, according to StatPearls.
Is There More Than One Screening for Dementia? Does It Matter Which One I Take?
There’s not an official statement or agreement among experts about which screening is the best; the most important thing is to get screened, says Cleveland. “And that can be once you turn 65 or maybe earlier if you have a family history of dementia or Alzheimer’s disease,” she says.
The more widely used screening tools typically take 10 minutes or less and include the Mini-Mental State Exam, Montreal Cognitive Assessment, Mini-Cog, and Saint Louis University Mental State Exam.
What’s Involved in a Cognitive Screening?
The screening will be given by a healthcare provider — usually a doctor or a nurse — and there’s nothing you need to do to prepare for the screening.
The Mini-Cog is basically two parts: Your provider will give you three words and ask you to repeat them back a few minutes later. Then they will have you draw a circular clock with the hands pointed to a specific time.
Cognitive screening tests check different areas of brain function, including orientation (date, where you are, your name), attention and short-term learning, short- and long-term memory, concentration, and the ability to use and understand language, according to the Cleveland Clinic.
Are There Online Screenings That Can Be Performed at Home?
The Self-Administered Gerocognitive Exam (SAGE) is a brief written screening tool designed to detect early signs of cognitive, memory, or thinking impairments, and it can be taken at home. Unlike other assessments, it doesn’t require an experienced or trained professional; you just need to be able to print out the test.
“People can take this test if they or a loved one notices that they are a little more forgetful than they used to be. It’s a helpful tool to assess if further evaluation is necessary,” says SAGE creator Douglas Scharre, MD, the director of the division of cognitive neurology at The Ohio State University Wexner Medical Center in Columbus.
The test takes about 10 to 15 minutes, and it measures a wide range of cognitive domains, such as orientation, language, reasoning, and memory. There is no answer key or scoring provided. After completing the test, you need to take it to your primary care doctor, who can score the test, interpret the results, and decide if you need further evaluation.
RELATED: All About the SAGE Test for Alzheimer’s and Dementia Detection
What Are the Next Steps After Cognitive Testing?
If your results indicate some level of cognitive impairment, more testing will be necessary to learn more about what’s causing it, says Cleveland. “Those will likely be performed by your primary care doctor,” she says.
Mild cognitive impairment doesn’t always mean that you’re going to get dementia. About half of people who have mild cognitive impairment have it for some other reason than the foreshadowing of dementia, says Cleveland.
One of the first steps to determining a cause is ususally looking at all the medications that a person is taking. “Sometimes it’s a medication that’s causing the cognitive issue. A common example is the antihistamine drug meclizine; it seems to affect memory in some people,” she says.
Thyroid issues, sleep issues, and vitamin deficiencies — especially vitamin B12 deficiency — can also cause cognitive problems, says Dr. Scharre. “If an underlying cause is identified and treated, the impairment will likely improve,” he says.
In some cases, a brain scan might be performed. “We’re looking for any evidence of small strokes, inflammation, tumors, infections, structural issues — any of these could be causing a person to not be thinking as well,” says Scharre.
What if I’m Diagnosed With MCI?
In some people, further testing will lead to a diagnosis of MCI. This is the space between expected cognitive decline that comes with aging and the more serious decline of dementia, says Cleveland.
Common signs of MCI include losing things more often than normal, forgetting appointments, or having trouble finding the right words. It can be easy to miss or to mistake for normal signs of aging, even by doctors. One study that examined Medicare data found that only about 8 percent of the 8 million people with MCI the researchers expected to find in these health records were actually there — meaning that more than 9 in 10 people with MCI may not realize they have it.
Although having MCI increases your risk for eventually developing dementia or Alzheimer’s disease, the symptoms of MCI can stay the same or even improve, according to the National Institute on Aging.
Your doctor can recommend lifestyle measures that may help slow any further cognitive decline.
Expert Lifestyle Recommendations for Brain Health
Scharre recommends good sleep, socialization, physical exercise, and good nutrition for brain health. “Sleep is very important. It seems to be a time where we remove toxins from our brains,” he says.
For the social piece, this can include chatting with people, interpreting information, and discussing issues, he says. “Your brain is like your muscles: Use it or lose it,” says Scharre.
“The best brain-healthy diet seems to be a Mediterranean-type diet — less red meat, more fruits and vegetables,” says Cleveland.
Both the MIND (Mediterranean-DASH Intervention for Neurogenerative Delay) and Mediterranean diets are associated with fewer signs of Alzheimer’s disease in the brains of older adults, according to a study funded by the National Institute on Aging.
Of all the lifestyle modifications, exercise has the strongest evidence. A review of 65 studies found that exercise was the most promising lifestyle intervention — meaning it improved various cognitive functions — for both MCI and dementia, and was most effective in MCI.
Talk With Your Doctor About Medications for Cognitive Impairment
Medications may help with MCI and early Alzheimer’s disease, says Cleveland. “These may help a certain segment of the population. This is a decision that can be made in partnership with your doctor,” she says.
Options include aducanumab (Aduhelm), lecanemab (Leqembi), and donanemab, which is expected to be approved in the near future.
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