As a geriatrician specializing in memory care, I have many patients who report noticing changes years before they see me. While it is never too late to get help, the earlier symptoms are addressed, the more that can be done. Evaluating cognitive symptoms requires a thoughtful and systematic approach. Here are suggested steps to take early in the process.
1. Talk to others about your experience.
Our brain changes as we age, and cognitive symptoms will develop. While these symptoms are normal, they can still cause worry. Age-related changes include slower processing of information, needing more repetition or cues to remember and word finding. Unfortunately, these same symptoms could be the earliest indicators of an abnormal process, too. It’s helpful to talk with others about what you’re experiencing. If they are also observing persistent changes in you, it would be beneficial to talk with your health care provider.
2. Collect your history. It’s the most important information in the evaluation.
Cognition is our ability to think, acquire knowledge and understand what’s happening in life. While memory is a part of cognition, other key functions include paying attention, using language, learning new information and problem-solving. Not all symptoms are related to memory. Your provider needs to understand exactly what you’re experiencing in the context of your life, and the timing and changes of those symptoms. Additionally, it’s critical to know your chronic health conditions and medications, family history, substance use and lifestyle habits. Many reversible conditions can cause thinking changes such as depression, medications, poor sleep, sleep apnea or thyroid issues. A cognitive evaluation includes investigating these potential factors.
3. Cognitive screening tests do not provide a diagnosis.
There are many different types of cognitive screening tests. They vary in length and what parts of the brain they’re testing. None provide a reliable diagnosis on their own. Cognitive screening tests won’t tell you if you have dementia, but a low score may suggest your thinking difficulties are caused by more than getting older. While a screening test can be done in a medical clinic, it can also be done over the phone or virtually by community organizations like the Alzheimer’s Foundation of America (go to alzfdn.org and click on the Memory Screening program tab for more info). If your provider is administering the test, make sure they know your symptoms, are looking for reversible causes and explain to you the test. Afterward, you’ll want to know how you did overall, the areas of the brain that didn’t perform as expected, and what this may mean in the context of your symptoms. Make sure you have enough time to discuss this fully.
4. Consider factors that may affect the testing and if the result aligns with your symptoms.
Determine if other factors may have contributed to your score. Were you prepared to take the test or was it “sprung on you”? Did you sleep well the night before? Did you take your regular medications or any sedatives before testing? If your score is low, determine if the results align with your symptoms. If you feel it is hard to multitask, did you score lower in the part of the brain where this function occurs? A lower score means more evaluation is needed. This will likely include blood tests, head imaging and possibly referrals to specialists. If you believe the test does not align with how you feel, then it is reasonable to repeat a cognitive screening test in 2-3 months. While waiting for that test, you can address reversible factors that may improve your symptoms.
5. Reflect on your symptoms and ask others for input.
Have you noticed changes and simply shrugged them off or attributed them to stress? Try to determine when your symptoms first started and how they have changed over time. It may be helpful to read a list of common thinking changes from questionnaires to see if they relate to your experience. Two available forms are the AD8 Dementia Screening and the Short IQCode. You may also want to keep a journal of your symptoms.
If you find yourself struggling to complete daily tasks, such as managing your finances or medications, this may be indicative of more serious brain changes. A change in performing daily activities should be reported to your provider immediately.
6. Follow up with your provider on the next steps in the evaluation.
Your provider may request a repeat cognitive screening test. It’s beneficial to take the exact same test to compare scores and determine any changes. Ensure you’re comfortable and prepared for this next test, but avoid practicing. You want your result to be accurate.
Your provider may refer you to a memory specialist who usually has training in neurology, geriatrics or psychiatry. Not all these specialists are experts in memory evaluations, so work with your provider to ensure you see the right person.
7. A diagnosis takes time. Address your brain health in the interim.
A comprehensive memory evaluation rarely is completed in one visit. While the evaluation is occurring, you can address reversible factors. Managing your lifestyle, medications and health conditions can significantly impact how you feel. Address hearing loss, high blood pressure, diabetes, depression and tobacco use. Engage in brain-healthy habits such as exercise, restorative sleep, mental and social engagement, healthy eating and stress reduction.
Being evaluated for memory and thinking symptoms can be scary. It’s important to remember you are not alone and medical professionals are available to help you. There are ways to help your brain, and many of them do not require medication. This help starts with a conversation.
For additional support, AFA offers a brochure, “Understanding Your Cognitive Screening Results.” To request a copy, contact the AFA Helpline at 866-232-8484 (phone), 646-586-5283 (text) or webchat at alzfdn.org.
ABOUT THE AUTHOR
Nathaniel Chin, M.D., is the medical director of the Wisconsin Alzheimer’s Disease Research Center and a member of the Medical, Scientific and Memory Screening Advisory Board of the Alzheimer’s Foundation of America.
