Test Your Brain Fitness

Other common cognitive assessment tests are MoCA and SAGE. XpressO, a digital version of MoCA, can be self-administered in four minutes on any device and in multiple languages, says its creator, neurologist Ziad Nasreddine.

MoCA is the most rigorous of them all, and research suggests it’s best suited for people with higher education levels. Someone who didn’t finish high school may lack the computation and language skills it requires. 

A more basic version of MoCA, called MoCA-B, replaces its number and word challenges with picture-based exercises. Visuals can transcend language, culture and education, researchers say, and reach a wider cross section of people. 

But even MoCA is still a simple test, with just 30 questions that should take about 15 minutes to complete. It is “by no means a sufficient measure of cognitive capacity for complex real-world tasks such as driving or making high-stakes financial decisions,” says Dr. Hyun-Sik Yang, a neurologist at Harvard Medical School.

The four images at the top of this story appear in a different test, the 5-Cog, designed by Stony Brook University neurology professor Joe Verghese. He says the 5-Cog works for virtually anybody, regardless of their education background. 

“Most tests out there can’t be done by people with low education or who can’t read,” he says; they may score poorly or fail to complete the test even if their brains are healthy.

None of these tests can offer a diagnosis of Alzheimer’s or other impairments. But what they can do is establish a baseline of one’s cognitive functioning, which can then be tracked over time. A low baseline score or a change in score could mean that more extensive testing is needed. Medication side effects, vitamin deficiencies and certain illnesses can also cause poor performance on cognitive tests; more thorough examinations rule out these factors.

Medicare covers cognitive testing as part of an annual wellness checkup for people 65 and older with Medicare Part B. But typically, fewer than 1 in 3 Medicare recipients take the test. Borson and others think these numbers will continue to improve — it used to be 1 in 4 — now that there are new drugs that might slow Alzheimer’s progression in people in the early-stages of disease. 

Here are seven common tasks found in these assessments.

1. Draw a clock face.

The clock-drawing exercise is a standard part of many of these exams. On a blank sheet of paper, draw an analog clock with hands showing a certain time — for example, 4:03. Sounds easy, right? Take a moment to draw yours.

Having to recall and draw a clock face offers clues about a person’s ability to understand, plan, concentrate and more. The left attempt here gets full credit because all 12 numbers are placed in proper sequence and position and the hands are pointing to the correct time.

The other two clocks tell a different story. These test takers have some cognitive deficits. Perhaps they couldn’t understand the instructions or were struggling to recall the structure of a clock and the numbers on its face. Those who placed the numbers and hands in the wrong places may have trouble judging spatial relationships. Executive functioning problems would’ve made it hard to think abstractly, plan and concentrate — all of which are necessary to successfully depict this familiar timepiece.

2. Follow the trail.

In this test, you connect alternating letters and numbers in ascending order; for example, you would go from A to 1 to B to 2 and so on. Putting two sets of unrelated symbols in a logical sequence engages brain circuits that regulate thoughts and action, which is part of executive functioning, says Nasreddine.

3. Identify the picture.

The test taker is asked to name a few things that don’t ordinarily come up in conversation. Two examples appear above.

Most of us don’t run into a rhinoceros every day or bump into a harp in the hallway. So it may take a second to retrieve the word. Getting that familiar “it’s on the tip of my tongue” feeling happens to everyone from time to time. Draw a blank routinely enough, though, and a doctor may wish to examine your language and memory functions in depth.

4. Place your right hand on your left knee.

Expressing language is one thing; comprehending it is another. Responding to this simple command tests your comprehension.

5. What’s left in your wallet?

For a more analytical challenge, try a question reminiscent of elementary school math:

You have $100 and you go to the store and buy a dozen apples for $12 and a tricycle for $20. How much did you spend? How much do you have left? Problems with simple calculations can signal a threat to one’s brain — and bank account. This challenge might identify people who’ve lost the higher-level thinking abilities that basic arithmetic requires.

6. Count backward from 100 by seven.

For some of us, subtraction never came easy — so struggling here wouldn’t raise a red flag for us. But maybe you were always a math whiz and now struggle. If so, it’s worth checking out.

7. Recall time.

Finally, what were those three words from the top of the story? (No cheating.) What about the pictures? Can you recall all four?

If the words don’t come to mind, don’t worry. Your brain may be fine. Missing a question or two doesn’t mean your cognitive powers are failing. It may just be a sign of poor sleep, stress or a multitude of other causes that are fixable and have nothing to do with age-related brain diseases.

Still, Verghese says the results on these exams are an important starting point for a conversation with your doctor.

Nasreddine agrees: “Cognitive screening is important for everyone — particularly if they are concerned about their cognitive performance.”