What do cognitive tests actually assess — and should you take one?

Keith Fargo, the director of scientific programs and outreach for the Alzheimer's Association, explained what a cognitive test is really like.
These are examples of questions on the Montreal Cognitive Assessment (MoCA), which is used as a screening tool for cognitive dysfunction - a loss of memory and clear thinking ability that can precede dementia.
These are examples of questions on the Montreal Cognitive Assessment (MoCA), which is used as a screening tool for cognitive dysfunction - a loss of memory and clear thinking ability that can precede dementia.Today Illustration / Ziad Nasreddine MD
/ Source: TODAY

Cognitive tests are having a moment in the spotlight right now, as President Donald J. Trump frequently talks about his experience taking them.

The tests can take a variety of forms and measure different skills depending on how they are administered. Keith Fargo, the director of scientific programs and outreach for the Alzheimer's Association, spoke with TODAY to provide more details about the exams.

What do cognitive tests assess?

"Brief cognitive assessments or tests are evaluation tools that health care professionals can use in the clinical setting to determine if an individual is experiencing cognitive decline or impairment," said Fargo, who is based in Chicago.

Different forms of the test assess different things. Verbal and written assessments, which can be "administered easily" during an appointment, evaluate cognitive functions including "memory, visuospatial awareness and language skills," noted Fargo.

"These short assessments are not used to make a diagnosis, but rather to determine, if more comprehensive testing/examination is needed," he said.

The tests can also be simply verbal conversations asking a patient about cognitive concerns or input from family and friends about any concerns or issues. A doctor's observations of the patient can also be considered. NBC News White House correspondent Kristen Welker noted on TODAY that the test does not measure a person's intelligence or IQ.

Who should take it?

The Alzheimer’s Association recommends that "anyone who has concerns about their thinking or memory ask their doctor or health provider for a cognitive assessment."

According to the association, cognitive tests are a "required component" of the Medicare annual wellness visit for any seniors over the age of 65 to establish a cognitive baseline so practitioners can compare responses from year to year.

Assessments can also be conducted if family members report being concerned about a relative's mental state.

Since age is a significant risk factor for Alzheimer’s, dementia and other illnesses, seniors are the most likely to need to take a cognitive test.

“Early detection of cognitive impairment offers several important benefits," said Fargo. "It offers an opportunity to diagnose and potentially reverse treatable forms of cognitive decline. For cognitive conditions such as Alzheimer’s and other dementias, early detection and diagnosis enables access to symptomatic treatments, more time for critical care planning, better disease management, participation in clinical trials and an opportunity for diagnosed individuals to have a voice in their future care.”

What is the test actually like?

While the tests vary, all are around the same length, ranging from three to 15 minutes.

"During an assessment, individuals may be asked to draw a clock and mark the hands at a specific time, memorize a short list of words and repeat them after a few minutes, or make easy calculations, such as counting backwards from 100 by seven," Fargo said. "The questions are usually not difficult for a person without cognitive decline, but are specially designed to be sensitive to changes in thinking and memory that may be early indicators of (mild cognitive impairment) or dementia."

What happens if a test shows any concerns?

Fargo said that if health care professionals do suspect a problem following a cognitive test, the next step is usually to conduct more comprehensive tests. In some cases, the patient may be referred to a specialist, who can make an accurate diagnosis.

Some cases of cognitive decline, such as decline attributed to depression, sleep apnea, vitamin deficiencies and other medical conditions, can be treatable. Other conditions like mild cognitive impairment and Alzheimer's disease can be managed and symptoms can be treated once diagnosed.