Moca Test
Memory Test
The Mini-Mental State Examination. The MMSE questionnaire gives a quick snapshot of cognitive capacity. It evaluates orientation, asking patients to name the day, date, month, year, and season. It asks them to pinpoint address, city, county, state, and, when appropriate, building floor.
It tests attention and recall: Those tested must identify three objects and then recall them after doing another task, such as spelling world backward. It asks patients to repeat a phrase, to read a set of instructions, and then to complete a three-step task. It asks patients to copy shapes and then to write a sentence.
This 10 minute office exam is a screen for dementia. It does not test for reasoning or judgment. It asks for date, month, year, place, city, county, state as well as short term memory and tasks for following instructions verbally, written, and special design. Of the 30 points, the general “cutoff” for a diagnosis of dementia is 24/30 depending on education and language ability. However, this does not test for abstract reasoning and judgment. A person could have a 30/30 and still not have capacity to make medical or financial decision. If there is concern about behaviors, especially risk of financial abuse; a neuropsychological exam is crucial.
Dementia Test
The Montreal Cognitive Assessment. The MoCA also has more abstract reasoning, making a trail between letters and numbers and is available in other languages, critical for a more accurate assessment. However, as above, it is only a screen and may not identify those who have lost their judgement. Neuropsychological testing is the gold standard to diagnose dementia, mental illness and capacity.
Cognitive Test
Neuropsychology testing. Standardized neuropsychological tests investigate the relationships between various brain behaviors, which doctors call “cognitive domains.”
These include attention and concentration, language, memory, visual/spatial judgment, and “executive functioning,” which is the ability to plan, initiate, and follow through on tasks.
The process usually involves interviews and a variety of written tests and other activities. The extent and expense of this testing vary widely. A healthy adult might be tested for four hours or more. At times several shorter sessions are required for an accurate assessment. If an elder becomes fatigued or irritable, the tests should be suspended for another day.
Of course, it is important to have the patient’s medications assessed and adjusted to make sure the function we see is from the person’s brain itself and is not affected by the use of alprazolam (Xanax), acetaminophen with Benadryl (Tylenol PM), oxybutynin (Ditropan), or levetiracetam (Keppra), which can all adversely affect cognitive function and behavior.