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Test Your Brain Fitness

What a simple battery of tasks can — and cannot — tell about cognition

spinner image a person filling in test bubbles in the shape of a brain
Kyle Ellingson

Banana. Sunrise. Chair.

Read these three words aloud and commit them to memory. If you can recall them by the end of this article, then you’ve passed a standard test doctors use to check brain fitness.

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While modern science has proven excellent at coming up with ways to test, measure and treat a huge range of illnesses, it continues to struggle to find a test or treatment for Alzheimer’s and other age-related brain disorders. But there’s one area of progress: We now have a series of tools that can roughly quantify just how well we’re holding up, mentally.

The four brain assessment tests most commonly used don’t measure intelligence or whether you are at peak mental performance. Rather, they test the lower end of your brain function, with the goal of pointing out early signs of impaired thinking or declining mental capabilities that need further scrutiny. They test skills like memory, spatial perception, attention and the ability to plan and make decisions — known as executive function — all of which can decline with age.

“If someone is concerned about their cognition or people close to them are concerned, then that person should have an evaluation,” says Soo Borson, M.D., professor of clinical family medicine at the University of Southern California.

Borson created the Mini-Cog, a widely used cognitive assessment that takes under three minutes to complete and involves just two tasks: a three-word recall and a clock drawing test. Other common cognitive assessment tests are MoCA and SAGE. XpressO, a digital version of MoCA, will be released this fall.

MoCA is the most rigorous of them all, and perhaps best suited for people with higher education levels. But it’s still a simple test, with just 30 questions, and it takes only 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 leading a powerful nation,” says neurologist Hyun-Sik Yang, M.D., of Harvard Medical School.

And 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 change in score could mean that more extensive testing, like brain scans or blood tests, is needed. Medication side effects, vitamin deficiencies and certain illnesses can also cause poor performance on cognitive tests. More thorough examinations rule those out.

Medicare covers cognitive testing as part of the annual wellness checkup for people 65 and older with Medicare Part B. But only 1 in 4 Medicare recipients typically take the test. Borson and others think these numbers will improve now that there are new drugs to treat dementia caused by Alzheimer’s disease.  

Here are seven common challenges found in these assessments.

spinner image clocks with numbers drawn on them
Kyle Ellingson

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. Plus, 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.

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spinner image arrows connecting different cups of different colors with number or letter labels
Kyle Ellingson

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 neurologist Ziad Nasreddine M.D., creator of the MoCA test.

spinner image left a portrait of a rhino right a portrait of a harp
Kyle Ellingson

3. Word retrieval.

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.

spinner image a person lifting their knee up
Kyle Ellingson

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.

spinner image price tags on a basket of apples and a tricycle
Kyle Ellingson

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 $3 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 can identify people who’ve lost the higher-level thinking abilities that basic arithmetic requires.

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Kyle Ellingson

6. Count backward from 100 by seven.

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

spinner image silhouettes from left to right of a banana a sunset and a chair
Kyle Ellingson

7. Recall time.

Finally, what were those three words from the top of the story? (No cheating.)

If those 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.

Nor does getting all the questions right or scoring perfectly on any of the assessments mean that you’re a genius. There are different tests for that.

So while cognitive testing isn’t going to tell us which presidential candidates are best for the job, MoCA’s Nasreddine sees a silver lining in the media’s focus on these tests: “Cognitive screening is important for everyone—particularly if they are concerned about their cognitive performance — as we get older.”

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