Screening for cognitive dysfunction

After a certain age almost everyone experiences "senior moments." You forget what someone just said, or you can't recall someone's name even when the face appears clearly in your mind. Maybe you forgot to put out the recycling even though you were certain you did.

Most of the time, we brush these episodes off as signs of normal aging. But what if they become more frequent or problematic, or if they affect your daily life — like missing a doctor's appointment or forgetting to pay a bill? What are your options?

"You shouldn't ignore frequent mental lapses, even if they seem innocent," says Julie Brody-Magid, neuropsychologist and clinical director of the Memory Disorders Assessment Clinic with Harvard-affiliated McLean Hospital. "There are steps you can take to determine if these are, in fact, benign age-related mental lapses or the signs of something more serious that requires additional assessment."

See your doctor

Your first step is to see your primary care physician to discuss your symptoms, review your overall health and concerns, and assess any family history of dementia, like Alzheimer's disease. During the visit, your doctor may conduct a brief screening test for cognitive function. This kind of test can help determine if a person has mild cognitive impairment (MCI).

In the spectrum of memory loss, MCI falls between the natural cognitive decline associated with normal aging and the more serious signs of dementia. With MCI, memory loss is noticeable, but usually does not affect a person's ability to carry out daily functions.

The most common screening tests are the Montreal Cognitive Assessment (MoCA) and the Folstein Mini-Mental State Examination (MMSE).

These assess brain skills like short-term memory recall, concentration, attention, ability to juggle multiple tasks, and orientation to time and place.

Both tests have similar formats and consist of 30 questions or tasks. Examples include

• identifying objects in pictures
• remembering and repeating a list of words or a five-number sequence in order and then in reverse
• quickly naming words that begin with a specific letter.

Taking the test

The MoCA takes approximately 10 to 12 minutes to complete, while the MMSE takes about seven to eight minutes. The top score for both tests is 30. A specific score does not indicate you do or do not have MCI. "However, the lower the number, the higher the suspicion for MCI or dementia," says Brody-Magid.

Many primary care physicians use the MoCA, as it is newer and has been found to have a 90% accuracy rate for detecting subtle MCI that MMSE may miss. "Other factors are also considered when evaluating the test results," says Brody-Magid. "For instance, lower-than-expected scores can be influenced by medication side effects or mental health issues like depression, anxiety, or grief."

Based on your test score and your doctor's assessment, you may be advised to undergo further testing at a memory clinic.

Finding your baseline

Even if the tests and medical exam do not suggest MCI, your doctor can help you address issues that may cause your mental lapses.

"Plus, this initial screening provides a baseline for future reference in case other memory issues arise, or your situation worsens over time," says Brody-Magid.

"Cognitive health is like any other health maintenance," she adds. "You get your heart and prostate checked out regularly, especially if there are suspected problems. Your brain deserves the same attention."

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