Patient advocate: You can check out your own cognition with new test

Some days, it feels like the neurons just aren’t firing. You call one child by another child’s name, can’t remember where you left your phone and forgot to pick up something at the grocery store.

Such forgetfulness becomes more common as we age, but it isn’t necessarily age-related. Lack of sleep and stress can cause stuff to leak out of our brains, too.

Memory lapses like these aren’t necessarily a sign of cognitive decline, either. They are generally manageable and can be overcome with strategies such as sending yourself text reminders, making to-do lists and maintaining a calendar.

That said, cognitive decline is a reality for millions of people around the world. In 2022, researchers at Columbia University found that almost 10% of U.S. adults ages 65 and older have dementia, while another 22% have mild cognitive impairment. That’s practically a third of our senior population.

In one of my columns a few years ago, I called dementia the “other pandemic,” because, for many people who had mild cognitive impairment before COVID, it blossomed into something more dramatic during our periods of isolation.

At your annual Medicare wellness exam, your health-care provider will screen you for cognitive difficulties by having you try to repeat back several random words and asking you to draw a clock showing a particular time. (With the number of young people today who can’t read a clock, they’ll have to come up with another test at some point!)

The Mini-Mental State Examination (MMSE), an 11-question standardized test that evaluates orientation, memory, attention, language and visual-spatial abilities, might be used for the Medicare assessment because it takes only five to 10 minutes.

If your provider feels your cognition needs further evaluation, they may refer you to a specialist who will perform the MoCA, or Montreal Cognitive Assessment. It takes only 20 to 30 minutes, and has long been validated as an effective tool for early detection of mild cognitive impairment in hundreds of studies. Its sensitivity for detecting cognitive impairment is estimated at 90%, and it is considered much more effective than the MMSE.

The MoCA is designed to assess:

The test has to be administered and scored by a trained clinician. Any medical professional can get the training, which takes only an hour and gives clinicians more confidence in administering the test and explaining the results to patients. Training and certification are free for students, faculty members, academic researchers and public health-care institutions.

Here are some of the activities the MoCA asks of us:

• Naming certain animals

• Counting backwards from 100 by sevens

• Saying as many words as possible that start with a particular letter in one minute

• Copying a simple drawing

• And, of course, drawing a clock and remembering a series of random words

Evaluating age-related cognitive decline isn’t the only use for the MoCA. People of any age who have suffered head trauma are often given the assessment to look out for immediate or delayed symptoms of cognitive damage. Many times, traumatic brain injury (TBI) is missed or misdiagnosed, which can leave a person with long-term cognitive issues.

Other conditions that might affect cognition are cancer treatment, Parkinson’s, depression, heart failure, brain tumor, sleep disorders and substance abuse disorders.

Now, though, you don’t have to wait for a doctor’s appointment to get a general assessment of your cognitive abilities or those of a loved one. The neurologist who developed the MoCA, Dr. Ziad Nasreddine, last year created XpressO, a quick and fun digital self-assessment designed for anyone to use on their own desktop computer, tablet or smartphone. (Laptop screens aren’t large enough.)

Once all the tasks are completed, you will receive a clear and simple report stating low or elevated risk of cognitive decline. You can monitor your cognition over time and share the results with your health-care provider.

XpressO requires registration and creation of a password. Learn more at MoCAcognition.com, or you can download the XpressO app from the Apple and Google Play app stores.

Dementia and cognitive decline, already a reality for millions, are a source of fear and anxiety for millions of others. Using this simple tool might put your mind at rest, or it may signal that you need to be talking to your doctor.

• Teri (Dreher) Frykenberg, a registered nurse, board-certified patient advocate, is the founder of www.NurseAdvocateEntrepreneur.com, which trains medical professionals to become successful private patient advocates. She is the author of “How to Be a Healthcare Advocate for Yourself & Your Loved Ones,” available on Amazon. Frykenberg offers a free phone consultation to readers. Contact her at Teri@NurseAdvocateEntrepreneur.com.